This paper focuses on the issue of synchronous settlement of commercial insurance empowered by medical insurance under a multi-level healthcare security system, and conducts research based on the practice in some regions. Currently, basic medical insurance achieves efficient direct settlement through a unified national information platform, while commercial insurance still mainly relies on post-incident claim applications. The lagging settlement mechanism has become one of the constraints on the development of commercial insurance. The article systematically analyzes two major types of practical models: medical insurance agency and data transmission (including direct/indirect connection and different data granularity sub-models), and dissects the operation mechanisms, advantages and disadvantages, and applicable scenarios of each model. It points out that the empowerment of medical insurance to commercial insurance shows characteristics of unidirectionality, dominance, and limitation. Then, it proposes an optimized framework for synchronous settlement of commercial insurance empowered by medical insurance, namely "one network, two platforms, three channels, four functions, and five guarantees", aiming to break the coordination barriers between basic medical insurance and commercial insurance, effectively solve the settlement bottleneck of commercial insurance, and promote the high-quality development of commercial insurance.