Only the actual medical expenses incurred by the insured person are reimbursed, and the reimbursement scope is different for different commercial medical insurance. Expense reimbursement type insurance it can reimburse hospitalization medical expenses, but the scope of reimbursement varies from product to product. Some commercial medical insurance contracts stipulate that actual medical expenses must be covered by social security in order to be reimbursed.
If you have already received compensation from the social security or other social welfare organizations, the insurance company will only pay the remaining portion of the cost, and if the social security is not able to reimburse you for the cost of imported medicines, special medicines, intensive care units, etc., this type of commercial medical insurance will not be able to reimburse you, and will only be able to reimburse you for the portion of the costs that you have to pay out of your own pocket proportionately after the reimbursement by the social security. On the other hand, some commercial medical insurance policies provide for the reimbursement of reasonable expenses incurred by the insurer on a pro rata basis or after a certain deductible.
2. The scope of reimbursement of urban medical insurance:
The following expenses incurred by insured persons at designated medical institutions and designated retail pharmacies are included in the scope of reimbursement of the urban residents' basic medical insurance fund:
(1) medical expenses incurred for inpatient treatment;
(2) medical expenses incurred in the seven days prior to the date of emergency and transfer to inpatient treatment;
(3) medical expenses incurred in accordance with the requirements of the urban residents' basic medical insurance fund;
(4) medical expenses incurred by the urban residents' basic medical insurance fund. p>(3) medical expenses in accordance with the provisions of special outpatient diseases for urban residents;
(4) other expenses in accordance with the provisions.