Generally speaking, good medical insurance can reimburse all expenses incurred in general department hospitalization, emergency treatment before and after hospitalization, special outpatient service and outpatient surgical treatment in public hospitals above level 2, including bed fee, medicine fee, meal fee, treatment fee and examination fee. Therefore, good medical insurance can reimburse the agreed hospitalization expenses.
Okay, medical insurance doesn't report hospitalization. For example, hospitalization expenses incurred by the insured due to the following circumstances shall not be reimbursed:
1. The hospitalization expenses of the insured due to accidents or diseases shall not exceed the deductible of good medical insurance;
2. The insured is hospitalized for plastic surgery, which belongs to the scope of exemption and will not be reimbursed;
3. The hospitalization of the insured for participating in the high-risk sports agreed in the insurance contract belongs to the scope of exemption and will not be reimbursed;
4. The insured is hospitalized due to self-injury or suicide, and will not be reimbursed;
5. The insured and the beneficiary intentionally cause the insured to be injured and hospitalized, and no compensation shall be paid.
Judging from the content of insurance, good medical insurance can also be reimbursed for ordinary hospitalization. Moreover, it is not only the reimbursement for ordinary hospitalization, but also the reimbursement scope of this product is much wider, such as:
1, general sickness and accident medical insurance
For insurance reasons, hospitalization, special outpatient service and general outpatient service caused by general illness or accidental injury of the insured can be reimbursed, as well as outpatient and emergency expenses 7 days before hospitalization and 30 days after hospitalization.
2. critical illness insurance
Good medical insurance can reimburse 100 kinds of major diseases, hospitalization, special outpatient service and outpatient surgery caused by major diseases during hospitalization, and outpatient and emergency expenses after 30 days of hospitalization for serious diseases. Moreover, when a serious illness occurs, good medical insurance is zero deductible, and you can pay directly without deducting the deductible.
Good medical insurance hospitalization is not fully reimbursed, and it needs to be reimbursed in proportion after deducting a certain deductible, and the medical expenses reimbursed by medical insurance are no longer reimbursed. In addition, the cost of purchasing supplements and materials for organ transplantation during hospitalization will not be compensated; If the remaining expenses after medical insurance reimbursement do not exceed the deductible agreed in the contract, good medical insurance will not be reimbursed.
Good medical insurance belongs to the medical insurance with cost compensation, and the reimbursement expenses will not exceed the sum of the medical expenses incurred by the insured in hospital.
In addition, the proportion of medical insurance reimbursement generally depends on whether there is medical insurance reimbursement, and the proportion of medical insurance reimbursement after medical insurance reimbursement is higher than that without medical insurance reimbursement.
legal ground
People's Republic of China (PRC) social insurance law
Article 2. The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-eighth, in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, as well as emergency and rescue medical expenses, in accordance with state regulations, paid from the basic medical insurance fund.