Accidental injury urban residents medical insurance reimbursement how much

Specific analysis: First, accidental medical: the insured person incurred less than 6,000 yuan of medical expenses, the reimbursement rate of 70%; more than 6,000 yuan of hospitalization medical expenses, the reimbursement rate of 80%, the maximum payment limit of 350,000 yuan.

The second is the accidental disability: the physical disability caused by the accident, depending on the specific circumstances to give a one-time subsidy, the specific standard is identified as disability grade 4, the subsidy of 20,000 yuan; disability grade 3, the subsidy of 25,000 yuan; disability grade 2, the subsidy of 30,000 yuan; disability grade 1, the subsidy of 35,000 yuan.

Third, accidental death: a one-time benefit of 50,000 yuan for death caused by an accident.

The following accidental injuries do not fall within the scope of reimbursement of urban residents' medical insurance:

If the accidental injuries occurring to the insured person meets the above requirements, but in one of the following cases, the accidental injuries are not reimbursed for the medical expenses: First, in addition to should be borne by the responsible person;

The second is to conceal, fraudulent behavior, including the provision of false traumatic injury time, location, cause of the accident

Third, the implementation of drug abuse, the use of controlled substances (except for medication prescribed by a doctor), fighting, drunkenness and other violations of the law caused by;

Fourth, the motor vehicle road traffic accidents;

Fifth, should be paid from the Workers' Compensation Insurance Fund or the Maternity Insurance Fund;

Sixth, the Those that should be borne by the public ****health;

seven are medical expenses incurred outside the country.

Accidental medical insurance, as the name suggests, covers outpatient or inpatient medical expenses due to accidental injuries. As long as the accidental injuries result in outpatient or inpatient medical expenses, basically, they are covered by accidental medical insurance.

What is covered by accidental medical insurance

As mentioned earlier, accidental medical insurance covers medical expenses incurred in hospitalization due to accidental injuries, and can reimburse the medical expenses incurred in hospitalization due to accidental injuries within the scope of the insurance coverage, as follows.

Accidental medical coverage: Most accidental medical insurance policies on the market have accidental medical coverage ranging from a few thousand to a few tens of thousands of dollars (there are also some accidental medical insurance policies with coverage as high as hundreds of thousands of dollars), which cover outpatient and surgical fees for hospitalization due to accidental injuries.

Reimbursement rate: Accidental medical insurance reimbursement is categorized into two types: restricted social security and unrestricted social security.

Restricted social security, that is, only reimbursement of medical insurance catalog within the scope of the cost, the medical insurance catalog outside the scope of the cost to be paid by the patient.

Unrestricted social security, i.e., the reimbursement is not only limited to the expenses within the scope of the social security catalog, but also reimburses the expenses inside and outside of the social security, which has a wider scope of reimbursement and a lower threshold for claims.

On the basis of restricted social security/unrestricted social security, the reimbursement rate of different accident medical insurance varies, as detailed in the insurance contract.

Deductibles: Most accident medical insurance policies on the market have no or very little deductibles, and if there is a deductible, it is generally $100;

Some accident medical insurance deductibles are based on whether or not the reimbursement is made through the social security system, and if the reimbursement is made through the social security system, there will be no deductible, and if it is not made through the social security system, there will be a deductible, please refer to the insurance contract for more details.