Everyone who buys a car knows that compulsory traffic insurance is compulsory traffic insurance stipulated by the state, because accidents are inevitable in driving safety, and human life is too fragile in the face of accidents. In order to have the most basic protection in the event of an accident, compulsory traffic insurance reflects its necessity. So, what items does the medical compensation of compulsory insurance include? Mainly the medical expenses for the entire rescue process and the expenses for postoperative rehabilitation, physical therapy, and rehabilitation guidance.
Out-of-hospital consultation fee, registration fee, meal fee, nursing fee, hair dryer, electricity bill, water bill, telephone bill, hospital gown, special cleaning fee, disposable daily necessities fee, medical record fee, escort fee, escort fee No charge will be paid for bed occupancy. Leave certificates for more than 3 months must be stamped with the official seal of the hospital's medical office.
1. Audit standards for medical expenses of each project
(1) Audit of medical expenses during the rescue period. In principle, medical expenses are based on medical insurance standards. For injuries that require special treatment, first of all, the rescue will be judged based on the hospital's monitoring and nursing level; secondly, reasonable and necessary self-paid drugs, imported drugs, monitoring fees, etc. will be provided based on the needs of the injury. An audit should be conducted to check whether the dosage and frequency of use are consistent with the damage, and the consistent parts should be approved. Such as surgical anesthetics, hemostatic drugs, blood transfusion (excluding blood transfusion assistance), oxygen delivery, monitoring, etc. After the vital signs are stable, the patient should be transferred to a general ward immediately and strictly follow the "Urban Employees Social Medical Insurance Drug Catalog".
(2) Review of medical expenses during hospitalization. All expenses during hospitalization will be reviewed according to medical insurance standards: expenses unrelated to injuries will not be paid; preventive medical insurance drugs related to work-related injuries will not be paid, and non-medical insurance drugs will not be paid; if they are related to the treatment of injuries, other drugs of the same type will not be paid. Under the circumstances, medical insurance restricted drugs and imported drugs with the same name as medical insurance drugs can be paid up to 50 according to the condition; used for routine examinations, such as B-ultrasound, X-ray, electrocardiogram, laboratory examination, etc. , where there is no obvious direct causal relationship with the injury during hospitalization, the maximum compensation amount can be paid once; large-scale examinations unrelated to the injury will not be compensated, injuries related to the injury will not be compensated based on the condition, and unnecessary repeated examinations will not be compensated ; The principle of compensation for repairing broken crowns or missing teeth that need to be installed or filled is based on local standards of 300-600 yuan (including treatment fees). For incomplete information (such as no medical records, lists, etc.), fees below 2,000 yuan will be reviewed after 30 days after the customer signs and agrees to bear them, and fees above 2,000 yuan will be reviewed according to the instructions after being signed by the person in charge. Special circumstances where the accident induces a certain disease or aggravates the original condition must be reported to the head office for approval before review.
(3) Surgical materials and auxiliary devices: Approved according to domestic popular standards stipulated in medical insurance, domestic luxury goods or imported materials are used, and the price difference is borne by the customer.
(4) Bed fee: based on local medical insurance standards. Except for those who need to stay in the intensive care unit due to acute brain trauma and combined visceral injuries, but they should be transferred to the general ward as soon as they are out of danger. (5) Rehabilitation and physical therapy fees: according to local medical insurance standards. In principle, there should be no more than 3 types, and rehabilitation physiotherapy outside the scope of medical insurance will not be compensated.
(6) Dressing change and rehabilitation function guidance training: Approved according to local medical insurance standards and condition needs.
(7) Ambulance fee: calculated according to the standards approved by the local health department and price department. Circle People's Insurance Network - China's largest insurance professional resource warehouse
(8) Other expenses: Expenses and questions and answers that are not compensable under the social medical insurance policy for urban employees will not be compensated.
(9) Medical renewal premium: In order to settle the case early, the insured can pay the necessary medical renewal premium in advance for the future of the injured person. The doctor in charge must clearly record on the discharge certificate or diagnosis certificate that the patient needs to continue treatment or take internal fixation after six months or one year, or regularly review or record the cost of follow-up treatment. At the same time, the compensation certificate provided by the insurance can record the follow-up before reviewing the cost of follow-up treatment. Fees have been paid. According to the needs of the patient's condition, if the patient's condition obviously exceeds the needs of the patient's condition, the follow-up diagnosis and review fee will not be compensated.
2. The following expenses are not within the scope of compensation
(1) Examination, treatment and related expenses unrelated to the insured accident (including the original disease of the injured; the injured has recovered, The doctor recommended that he be discharged from the hospital, but the injured person refused to be discharged)
(2) Expenses for medical accidents and error expansion.
(3) Medical expenses incurred after unauthorized transfer without our company’s transfer certificate or consent.
(4) Expenses incurred for outpatient or out-of-hospital services (including purchase of drugs, equipment, etc.). ) during hospitalization due to non-special diseases or with the consent of our company.
(5) Computerized invoices can be provided for hospital treatment costs at or above the county level, unless required by special diseases or agreed by our company.
(6) Paid expenses such as work-related injury insurance, urban employee basic medical insurance or other commercial insurance (such as accident insurance).
Compared with foreign countries, the insurance awareness of our people is relatively backward. However, cars are called tigers on the road, and traffic accidents are inevitable if you are not careful. Therefore, the state requires compulsory traffic insurance, and this behavior is actually the most stable insurance for car buyers.
One million car purchase subsidies