LEGAL ANALYSIS: Commercial health insurance will reimburse at different rates depending on the specific regulations of the product. Usually, the reimbursement rate is around 80% with social security health insurance, and around 70% without social security health insurance.
The reimbursement rate is variable, and the scope and rate of reimbursement varies from one type of insurance to another. Commercial medical insurance can generally be divided into two categories according to the nature of the insurance: expense-type and benefit-type, which can be reimbursed according to the following forms according to the type of insurance:
1. Expense-type commercial medical insurance reimbursement: The insurance company will determine the items that can be compensated according to the terms of the insurance policy (generally the same as the scope of social security claims), and then pay the actual reasonable and necessary medical expenses after deducting the deductible. After deducting the deductible, the insurance company will reimburse the actual reasonable and necessary medical expenses incurred.
2. Benefit-type commercial medical insurance reimbursement: commercial critical illness insurance is generally diagnosed that is paid, the insured person can rely on the hospital issued a certificate of diagnosis, a one-time insurance amount of hunger. Benefit-type insurance is also not reimbursed on the basis of invoices. As long as you provide proof of the occurrence of surgery or hospitalization (specific product regulations), you will be able to obtain insurance benefits from the insurance company.
Legal basis: The People's Republic of China Social Insurance Law
Article 28: The medical expenses in conformity with the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical service facilities, as well as those of the emergency and rescue shall be paid out of the basic medical insurance fund in accordance with the provisions of the State.
Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and pharmaceutical business units. The social insurance administrative department and the health administrative department shall establish a settlement system of medical expenses for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance treatment by the insured.