Is commercial insurance deducted from medical insurance reimbursement?

The part of commercial insurance reimbursement deducted from medical insurance.

Medical insurance reimbursement for general commercial insurance is that after deducting social insurance reimbursement, the remaining expenses are reimbursed by the insurance company from 90% to 100%, and the actual expenses are reimbursed according to the insurance contract. Commercial insurance can only reimburse the remaining amount of the insured after medical insurance reimbursement, but not in full according to the invoice, and medical insurance and commercial insurance cannot be reimbursed repeatedly.

The reimbursement standards for commercial insurance after medical insurance reimbursement are as follows:

1. After medical insurance reimbursement, commercial insurance can generally only reimburse the remaining part of the medical insurance scope, including the part below the deductible line, the part above the capping line and related expenses other than 50% to 70% of the medical insurance reimbursement ratio;

2. If it is a small medical insurance with a low deductible or even no deductible, it can be reimbursed according to its proportion after medical insurance reimbursement;

3. If it is a million-dollar medical insurance, the deductible of most million-dollar medical insurance is 1 000. After deducting the deductible, the general medical reimbursement will be reimbursed in proportion, and the proportion after medical insurance reimbursement is generally 1.000%.

4. Medical insurance and commercial medical insurance cannot be paid repeatedly, because medical insurance belongs to the nature of reimbursement and will be reported first;

5. If it is after medical insurance reimbursement, the payment of critical illness insurance is paid immediately after diagnosis, which has nothing to do with medical insurance reimbursement. As long as it meets the definition of disease, it can be paid.

To sum up, if an individual who participates in the basic medical insurance for employees reaches the statutory retirement age and the accumulated payment reaches the fixed number of years stipulated by the state, he will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.