The following provisions on reimbursement apply to the principle of compensation.
1. During the insurance period, if the insured suffers from accidental injury or illness and must be hospitalized after being diagnosed by the hospital, we will pay the supplementary hospitalization medical insurance premium according to the agreed proportion after deducting the deductible of reasonable medical expenses incurred in each hospitalization 100 yuan.
If the insured has been insured for social security, but the hospitalization medical expenses have not been settled by the local social basic medical insurance management department in advance, the company will reduce the compensation ratio to 25% after deducting the deductible 100 yuan from the reasonable medical expenses that meet the requirements of the local social basic medical insurance for each hospitalization;
During the insurance period, if the insured needs hospitalization due to an accident or illness, the general hospitalization allowance will be paid from the fourth day of each hospitalization of the insured. The number of days paid for each accident is limited to 15 days, and the upper limit of the number of days paid is 180 days.
2. There is no waiting period for the insured hospitalization allowance, in which the general hospitalization allowance is paid daily according to the allowance amount specified in the insurance policy from the 4th day of each hospitalization, and the compensation days for each accident are limited to 65,438+05 days, and the total compensation days are limited to 65,438+080 days within the validity period of this contract.
During the insurance period, if the insured suffers from cancer for the first time and must be hospitalized after being diagnosed by the hospital, the cancer hospitalization medical allowance shall be paid according to the actual hospitalization days, and the longest cumulative payment days shall be 180 days.
During the insurance period, if the insured is diagnosed by the hospital due to an accident or disease and performs surgery, the surgical medical subsidy will be paid according to the surgical items implemented by the insured, and the limit of surgical medical subsidy is 5000 yuan.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.