Should hospitalization expenses be paid in social security or commercial medical insurance first?

Many people have this confusion. The unit already has social security. Is it necessary to buy another commercial insurance? Want to buy, how to buy better? When making claims, how to give full play to the effects of social security and commercial insurance?

Generally speaking, commercial insurance has certain payment principles:

When medical claims occur, social insurance takes precedence over commercial insurance, that is, after social insurance pays, the insurance company will pay for the remaining medical expenses.

When an insurance company makes a claim, it will first exclude the expenses paid by social security, and then make a claim according to the scope and proportion of disease compensation agreed in the insurance contract.

For example, George W. Wang Mai bought a commercial insurance, with a reimbursement limit of 20,000 yuan and a deductible of 200 yuan. He pays 90% for those with social security and 80% for those without social security.

If Xiao Wang spends a total of 8,000 yuan in hospital, it is within the scope of compensation agreed in the commercial insurance contract.

So Xiao got the following compensation:

A: Xiao Wang has social security and can be reimbursed 50%. The insurance company will pay:

(8000 yuan -8000 yuan *50%)*90%=3600 yuan;

The small total compensation is: social security 4000 yuan+commercial medical insurance 3600 yuan =7600 yuan.

B: Xiao Wang has no social security, and the insurance company will pay for it:

(8000 yuan -200 yuan) *80%=6240 yuan;

The small amount of compensation is: 6240 yuan.

note:

(1) Both social security units and insurance companies need to submit an invoice for reimbursement. Therefore, when handling social security reimbursement, staff should be reminded to issue separate commercial insurance reimbursement invoices.

(2) If you hold medical insurance from multiple insurance companies at the same time, the insured shall provide insurance information from other companies when making claims. In principle, many insurance companies will share the insurance amount in proportion, bear the insurance liability and pay the insurance amount they bear.

If the claim is settled by one of the insurance companies first, the insured should explain his insurance situation to the insurance company, and ask the insurance company to provide the corresponding statement, provide the corresponding certificate, invoice or copy of medical expenses to other companies, and indicate the amount of the claim. Even if the insurance company doesn't pay, it will still indicate it.

For more questions about insurance, please come to snail insurance and ask me ~

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.