I. Accident insurance reimbursement
1, death benefit
When the insured suffers accidental injury and causes death, the insurer pays death insurance money. Death compensation is full compensation.
2. Disability allowance
When the insured is disabled due to accidental injury, the insurer shall pay disability insurance money according to the degree of disability. Disability allowance is paid separately.
3. Medical payment
When the insured pays medical expenses due to accidental injury, the insurer shall pay according to the facts. There is a maximum amount of medical compensation, and accidental injury medical insurance is generally not covered separately, but as an additional insurance for accidental injury, death and disability.
4. Payment for shutdown
When the insured is temporarily unable to work due to accidental injury, the insurer shall pay the shutdown insurance money.
Second, medical insurance reimbursement
1, the insured person must go to the designated medical institution of basic medical insurance or the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital.
2. The medical expenses incurred by the insured in the process of medical treatment must conform to the scope and payment standards of the basic medical insurance drug list, medical treatment items and medical service facilities standards, so that the basic medical insurance fund can be paid according to regulations.
3. The medical expenses incurred by the insured that meet the payment scope of basic medical insurance shall be paid by the social medical pooling fund in a unified proportion, with the expenses above the Qifubiaozhun and below the maximum payment limit.
Extended data:
I. Amount of accident insurance
Accident insurance is based on human health. Adopt fixed value insurance. The insurer determines the total insurance amount by combining the economic value of life, the accident rate, the average expense rate and the overall wage income level at that time, and then it is approved by the insured.
The minimum amount of group accident insurance is 1000 yuan, and the maximum amount is 500,000 yuan; In personal accident insurance, the minimum insured amount is 1000 yuan and the highest is 1000 million yuan. Once the insurance amount is determined, it cannot be changed halfway.
Second, the proportion of medical insurance reimbursement
1, students and children
In a settlement year, medical expenses less than 6,543,800 yuan+0.8 million yuan that meet the scope of reimbursement occurred. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
2. At least 70 years old and above.
In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
3. Other urban residents
In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold for tertiary hospitals is 659 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.
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