Medicare is a national welfare insurance, which is closely related to everyone's life and can effectively transfer the risk of minor daily illnesses. But if it is not sick, but an accident, such as car accidents, falls, burns, etc., medical insurance can be reimbursed?
Many people assume that all accidents are covered by their health insurance, but this is wrong.
Let's take a look at a case that involves reimbursement for accidents.
A driving a car and Zhang driving an electric car collided, resulting in B injured. B*** spent 8409.98 yuan in medical expenses, 802 yuan reimbursed by the new rural cooperative, out-of-pocket expenses 7607.98 yuan.
The traffic police brigade determined that: A is fully responsible for the accident, B is not responsible.
After the accident, B sued A and the insurance company for 36,965.78 yuan in compensation for medical expenses, nursing care, nutritional expenses, disability compensation and other economic losses.
The trial, both sides in the nursing costs, nutritional costs, disability compensation is not much disagreement, the main focus of the argument is: B in the new rural cooperative medical reimbursement of 802 yuan, whether it should be deducted from the compensation?
The insurance company argued that the medical insurance is a compensatory insurance, and the reimbursed medical expenses cannot be reimbursed repeatedly.
But the court held that, in accordance with the relevant provisions of the new rural cooperative reimbursement, traffic accidents do not belong to its reimbursement, the amount of reimbursement of the plaintiff B should be collected according to the law, and turned over to the state.
The court's attitude in the case is very clear, traffic accidents such as these accidents, medical insurance can not be reimbursed.
So, what are the cases are not reimbursed by health insurance?
In fact, from a national perspective, traffic accidents involving a third party cannot be reimbursed by Medicare, as specified in the Social Security Act.
Summarizing, health insurance can not be reimbursed can be roughly divided into two categories:
One is the overseas medical treatment, which there is nothing to say, health insurance is only the basic protection, the high cost of overseas treatment is certainly not reported.
The other category is borne by other individuals or organizations, and not reimbursed by health insurance. This is because medical insurance, like other medical insurance, is an expense reimbursement insurance and cannot be reimbursed repeatedly.
This, should be borne by other organizations, such as everyone in the five insurance and one gold have to pay for work injury insurance, should be borne by the public **** health refers to the prevention and treatment of major infectious diseases (SARS, AIDS, etc.), a class of vaccinations, health campaigns, etc., by the government's financial burden, individuals do not have to spend money, the health insurance fund will not be compensated for additional.
And those that should be borne by a third party are most closely related to accidents.
Generally speaking, accidental injuries in life can be categorized into two types according to the responsible person:
The first one is, accidental injuries caused by other people, such as being hit by a car, or being hit by objects thrown from a height.
The second type is, accidental injuries caused by oneself, the whole process does not involve a third person, such as falls, burns, cuts and so on.
According to the agreement of the Social Security Law, in the first case, the medical insurance is not reimbursed, and can only seek compensation from the "third person". However, the lawmakers also took into account the actual situation, if "the third party does not pay or cannot be identified", the health insurance can pay first, and then recover from the third party.
Medicare will not reimburse for accidents involving a third party, such as traffic accidents, or if there is concealment of fraud, intentional crime, suicide, drug abuse, drunkenness, fighting and assault, and other illegal and criminal situations.
However, accidental falls and burns that do not involve a third party are also very common in life, and for these cases, can the medical insurance reimbursement?
Generally speaking, accidents caused by personal carelessness, such as falls and burns, can be covered by health insurance.
Isn't that a big relief for everyone?
However, it is still highly recommended to have accident and medical insurance. There are several reasons for this:
First of all, the process of reimbursement for medical insurance accidents is more complicated, and it is difficult to get reimbursed in a timely manner.
Secondly, the third party involved in the responsibility can not be reimbursed, if a serious traffic accident, and meet the other side can not afford to repay, medical insurance and can not be reimbursed in time, it will be very troublesome. If you buy commercial insurance, after a car accident, not only can you get timely compensation from the insurance company, but you can also continue to claim compensation from the tortfeasor, so that you can get more than one compensation.
Finally, health insurance only compensates for medical expenses, but not disability liability, and if you are disabled due to an accident, your future life may still be affected. Accident insurance can provide disability protection, and even if you are disabled, you can still get a sum of compensation for subsequent rehabilitation and supplementing your family's income.
So, medical insurance is only the basic protection, if you want more adequate protection, commercial insurance is essential. In addition, fighting, suicide, drug abuse and other behaviors, accident insurance and medical insurance is basically also exempt, do illegal things, or do not expect others to bottom of the good.