How should paid twice Hospital Insurance Insurance Tips

Category: Insurance tips Release Date: 2006-08-01

These two pots of insurance should be paid what a primary school teacher Ms. Wang in 1997 with the school all the teachers of the Ping An Insurance Add sickness insurance hospitalization medical insurance. She was hospitalized twice in 2003 spent a few thousand dollars maintenance fee, the insurance company paid for her hospital twice the amount of different standards for claims payment, Ms. Wong this challenge.

Ms. Wang: Why the two different payment

Ms. Wang in 1997, organized through schools, with school students in the Ping An Insurance Add-sickness insured hospital medical insurance, and every year a 38 yuan insurance premium paid on time. In April 2003 and 12 months, she was hospitalized twice due to illness, respectively, spent 2770 yuan and 2900 yuan hospital costs. After discharge from hospital, Ms. Wang's insurance company required to be paid. The first payment, insurance companies, according to the provisions of the insurance contract between 1,000 yuan to 3,000 yuan for medical expenses paid by 50% of the proportion of the compensation of Ms. Wang 1385 yuan; on the second hospital fees paid, the insurance company that Ms. Wang has been promoted through the social health insurance claims of 2,000 yuan, so the insurance company paid should be reimbursed at cost, and Ms. Wang to remove this individual pays part of the actual ratio of 50% paid by the compensation of Ms. Wang 390 yuan. Ms Wong this wonder of their own in the same year was hospitalized twice before and after the insurance company paid the amount of the difference is too great, different payment standards puzzled that the insurance company paid improperly.

Insurance: Insurance is not a profit nature of the

In this regard, the insurance company concerned explained that Ms. Wang insurance companies insured the insurance to take care of school teachers, with school students in China Life insurance students, child care group Ping An Insurance Add-disease hospital medical insurance. As teachers age, physical condition and students a greater difference between insurance contracts entered into when the insurer has agreed with the school, indicating teachers to disease hospitalization, insurance companies, teachers, social health insurance should be reimbursed to remove the rest and then the proportion of the insurance contract paid, and this agreement the school has not timely communicated to individual teachers, which led to Ms Wong's puzzled. Insurance companies stressed that the insurance company that the compensation paid by the insurance nature of the decision. Health insurance as a loss of compensatory insurance, in addition to a fixed scope of health care insurance, the amount shall be paid within the insurance amount and the maximum can not exceed the insured the actual costs incurred, when insurance companies and the insured entered into insurance contracts to take effect . The insured employee medical insurance reimbursement by hospital charges should not be part of the insurer paid the insured duplication and avoid leading to two insurance claims and more than the insured's medical expenses actually incurred to insure a profitable behavior.

Law: Commercial insurance and social insurance, or how the gap to be defined

Enda 10000 law firm lawyer that because the social workers of medical insurance is compulsory insurance, Ms. Wang made with the insurer Ping An Insurance Add-disease hospital medical insurance is commercial insurance. Ms Wong's two sum insurance payment of commercial insurance and how the interface between the social insurance, to define the problem. In his view, "Insurance Law" embodies the principle of compensation, if the insured has been compensated in the social insurance, the insurance company would only be in addition to compensation payments of social insurance, the insured can not make an additional benefit. In accordance with the principles of the contract, from the legal point of view, as Ms. Wang with the insurance company entered into the commercial insurance contract, she appeared in an accident insurance, the insurance company should be in accordance with established commercial insurance claims under the contract the amount of claims. Therefore, Ms. Wang Debu be legally able to justify claims.