1, the definition is different:
Accident insurance is the insurance that pays insurance benefits to the insured for death, disability, or temporary incapacity or medical expenses caused by accidental injury. Here is the accident refers to unintentional, non-disease, sudden, external accidents. Accident insurance is to cope with the risk of accidents, accidental death / total disability insurance benefits can be used as a family life and debt repayment of financial support, accidental medical treatment is to alleviate the cost of accidental medical expenses.
The so-called medical insurance is based on the insured's body suffered a disease attack, in line with the requirements of the contract, the insurance company will be reimbursed for the insured treatment of the medical expenses of the insurance, is an important supplement to the social security;
2, the scope of coverage is different:
The two are different, but there is overlap, such as the two have accidental medical. However, they are different, such as medical insurance for disease medical coverage, while the accident insurance is not, because the accident insurance requirements are non-disease that disease caused by the accident, accident insurance does not pay, while the medical insurance can protect the disease medical;
3, the different ways of payment:
Medical insurance is a reimbursement type, which is often referred to as the first treatment, and then reimbursement. Accident insurance is a payment + reimbursement, if the insured person unfortunately suffered an accidental death, the insurance company will pay a one-time payment of the agreed insurance benefits; however, accidental medical treatment is also the same as medical insurance is the first treatment and then reimbursement.
1, accident insurance does not pay the situation in general what are the circumstances?
1, suicide/intentional self-injury: suicide within two years of insurance, as well as intentional self-injury does not belong to the accident, the insurance company will not pay;
2, death due to illness: disease as the direct cause of death, is not accidental, such as death due to a fall;
3, sudden death: sudden death of sudden death of disease and sudden death due to overwork, do not belong to the accident, the general accident insurance not
4, heatstroke death: heatstroke and the patient's body functions, physical quality, the insurance company usually does not pay;
5, pregnancy accident: the insured person due to pregnancy leads to an increase in the risk of accidents, is generally not compensated for;
6, food poisoning: individual food poisoning may be the cause of the body, the accident insurance does not pay, but three or more than 3 people Food poisoning is normally covered;
7, surgical accidents: surgical accidents, the nature of the disease is due to the nature of the injury is not an accident;
8, other non-compensation: plateau reaction, diving insurance deaths, etc. does not belong to the case of the accident.
Second, what items are not included in the scope of reimbursement of medical insurance?
The items that are not covered by the medical insurance are as follows:
1, non-disease treatment programs
Weight loss, weight gain and height projects; beauty and fitness programs and non-functional cosmetic and orthopaedic surgery; health check-ups; preventive health care treatment programs and medical consultation, appraisal of the type of project;
2, services
Registration fees, out-of-hospital consultation, and other fees are not covered by the medical insurance. Registration fees, out-of-hospital consultation fees and medical records; doctor's visit fees, expedited examination and treatment fees, additional fees for specified surgeries, special nurses, etc. to meet their own special needs for medical treatment services;
3. Diagnostic and therapeutic equipment and medical materials
Application of large-scale medical equipment for examination and treatment programs such as Positron Emission Tomography (PET) scanners, electron-beam CTs, and ophthalmology excimer laser therapeutic devices. Medical equipment for inspection, treatment projects; mirrors, denture, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitative appliances; a variety of self-use health care, massage, inspection and treatment equipment; the provincial price departments can not be charged separately for disposable medical;
4, therapeutic projects
various types of organ or tissue transplantation of organ or tissue source; in addition to the kidney, heart valves, cornea, skin, blood vessel , bone and bone marrow transplants other than organ or tissue transplants; myopic eye orthopedics; qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other complementary therapeutic programs.
In summary, accident insurance can reimburse the insured for accidental death or disability due to accidental injury, accidental medical care, etc.; medical insurance can mainly reimburse the insured for reasonable and necessary medical expenses due to accidents or illnesses, and the scope of reimbursement for different medical insurance varies, for example, hospitalization medical insurance can only cover reasonable and necessary hospitalization medical expenses due to illnesses or accidents, and the insurance can only reimburse the medical expenses due to illnesses or accidents. For example, hospitalization medical insurance can only cover reasonable and necessary hospitalization medical expenses incurred due to illness or accident; death and disability in accident insurance is a fixed amount of payment, and multiple accident insurance can make repeated claims; medical insurance is a reimbursement type of insurance, and multiple medical insurance can't be reimbursed repeatedly.
Legal basis:
Article 30 of the Social Insurance Law of the People's Republic of China
The following medical expenses are not included in the scope of payment of the basic medical insurance fund:
(1) those that should be paid out of the Workers' Compensation Insurance Fund;
(2) those that should be borne by a third party;
(3) those that should be borne by the Public **** Health to bear;
(iv) medical treatment outside the country.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.