Reimbursement should follow the principle of social security first and commercial insurance later. When consumers reimburse, they should follow the principle of social security first and commercial insurance later. Reimbursement must be made through social security and commercial medical insurance first.
Because there are many parts of social security that cannot be reimbursed, such as deductible, these non-reimbursable money can also be reimbursed through commercial medical insurance. As long as the insured takes the bills that cannot be reimbursed, that is, the social security split sheet, it can be reimbursed by the commercial insurance company. If there is only one document, the original can be used for social security reimbursement and the copy can be used for commercial medical insurance.
However, it should be noted that reimbursement of medical insurance belongs to the nature of reimbursement. According to the principle of cost compensation, the total amount of medical insurance reimbursement and commercial medical insurance reimbursement in social security cannot be higher than the total amount of actual medical expenses.
Extended data
The difference between commercial insurance and social medical insurance
1, their properties are different.
Commercial medical insurance is a kind of insurance operated by life insurance companies by means of economic compensation, and it is an aspect of social and economic activities, which is realized by signing contracts between insurers and policyholders on a voluntary basis.
Social medical insurance is a social security system established by the state according to the Constitution to protect and improve the health of employees. It is enforced by state or local legislation, regardless of individual will. At the same time, as a social welfare undertaking, it has a non-profit nature.
2. The objects and functions of insurance are different.
Commercial medical insurance takes natural persons as the insurance object, and its function is that when the insured citizens pay medical expenses due to accidental injuries or diseases, they can get certain economic compensation to reduce losses, not to protect the basic life of the insured, nor to maintain social justice;
Social medical insurance is mainly aimed at workers. When workers pay for medical treatment due to illness, the social insurance department or its entrusted unit will give them basic compensation, which is conducive to social stability and social equity, and is actually an aspect of national income redistribution.
3. The reciprocal relationship between rights and obligations is different.
The rights and obligations of commercial medical insurance are based on the contractual relationship. Any citizen or legal person with full capacity only needs to sign an insurance contract with the insurance company voluntarily and pay the insurance premium according to the contract.
The relationship between rights and obligations of social medical insurance is based on labor relations. Workers can enjoy social medical insurance benefits as long as they fulfill their obligations of working for the society, sometimes to facilitate economic management and enhance their awareness of expenses;
They need to pay a small amount of insurance premium, but the insurance premium they get is not proportional to the amount of insurance premium they pay, that is, the relationship between rights and obligations is not equal.
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Xinhuanet-Is there a conflict between social security and commercial medical insurance when reimbursing expenses?