How much can be reimbursed by supplementary medical insurance, and how much can be reimbursed by sup

Legal analysis: the medical expenses borne by individuals in proportion to the payment scope of the basic medical insurance (excluding the part below the minimum payment standard) and the payment of the mutual aid fund for large medical expenses (excluding the part below 1,300 yuan for outpatient services) shall be reimbursed by the unified supplementary medical insurance for retirees 50%, that is to say, the burden of medical expenses for retirees can be solved by the unified supplementary insurance.

Legal basis: Social Insurance Law of the People's Republic of China

Article 2: The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Supplementary medical care is voluntarily participated in by employers and individuals compared to basic medical care. After the basic medical care of the unit and the employee has been dealt with, the medical insurance items shall be appropriately increased according to the relevant needs of the unit or individual.

Corporate supplementary medical care, commercial medical care, social mutual aid and community medical care are all complementary medical care, as a powerful supplement to basic medical care. Like social security and commercial insurance, it is also a complementary relationship, I won't say too much here, if you are interested, you can click here:"If you have social security, you don't need to buy commercial insurance?

The difference between social security and commercial insurance is **

1.We pay for supplementary medical care once a year, you can pay this year, not next yearYou can be reimbursed for the year you pay, and you won't be reimbursed if you don't pay it.

2.Complementary medical care can be reimbursed in the usual medical purchasesMedical reimbursement must be at least three days of hospitalization before it can be reimbursed.

3.There is a certain reimbursement scope for complementary medical careChildbirth, plastic surgery, etc. do not agree to reimbursement, generally half of the company pays, and they are responsible for half of it.

4.Friends who have already paid for supplementary medical careWhen you see a doctor, pay attention to the medical records, lists, and invoices. It is necessary to take the medical records and lists to be stamped and invoices to be reimbursed, and no one of the three can be missing.

5.After that, you can go to the human resources department and submit your medical records, lists, and invoices for reimbursementYou need to fill in the relevant ** and provide the bank card number, and the time to receive the reimbursement is about a month.

Some friends finally have a general understanding of complementary medicine here, in order to let you have a more complete understanding, I have already prepared for you to be considerate of medical insurance reimbursement related issues, for your reference:Under what circumstances will medical insurance not be reimbursed? 》

1. The reimbursement scope of supplementary medical insurance will be different due to different policies in various regions.

The following is mainly taking Beijing as an example, the supplementary medical insurance premiums of the unit can pay the following expenses incurred by retirees and employees in designated pharmacies and medical institutions, as follows:

1. The medical expenses that should be paid by the individual in addition to the basic medical insurance co-ordination**;

2. Medical expenses when the personal account is insufficient to pay;

3. Medical expenses that should be paid by individuals in addition to the mutual aid fund for large medical expenses.

The circumstances under which the supplementary medical insurance of the unit is not reimbursed are as follows:

Second, the unit supplementary medical insurance is not reimbursed, mainly including the following points:

1. All outpatient and inpatient medical expenses of non-designated medical institutions, as well as medical expenses that do not meet or exceed the scope and standards of basic medical insurance reimbursement;

2. The cost of drugs that do not match the diagnosis, self-financed drugs, and purchased drugs other than the requirements of basic medical insurance;

3. All medical expenses caused by suicide, self-harm, drug abuse, fighting, brawls, alcoholism, traffic accidents, medical accidents, etc.;

4. All medical expenses incurred abroad and all medical expenses for medical treatment and hospitalization in special outpatient clinics;

5. All medical expenses for pre-pregnancy examination, all medical expenses for diagnosis and treatment of infertility, all medical expenses for preventive drugs, and medical expenses that should be paid by individuals in accordance with national and municipal regulations.

When it comes to basic medical insurance, everyone must be familiar with it, because there are many people who have purchased this type of insurance, but when it comes to supplementary medical insurance, everyone is relatively unfamiliar, because many people don't know how much supplementary medical insurance can reimburse? Below I have compiled some content related to it for you, friends in need can take a look.

1. How much can be reimbursed by supplementary medical insurance.

About 50%.

Within the scope of the basic medical insurance co-ordination ** payment and the payment of large medical insurance cost mutual aid funds, the medical expenses that need to be borne by the individual in accordance with the corresponding proportion can be reimbursed by supplementary medical insurance at a rate of 50%, that is, the medical expenses that need to be borne by themselves can be reimbursed half after the supplementary medical insurance.

After the establishment of unified supplementary medical insurance, for retirees under the age of 70, the outpatient reimbursement ratio can basically reach about 85%, and individuals only need to bear about 15%; For the elderly over 70 years old, the reimbursement ratio of outpatient expenses can reach about 90%, and individuals only need to bear about 10%.

2. How to reimburse supplementary medical insurance.

1. Prepare the corresponding information and documents according to the requirements, the data documents need to be true and complete, and they can be submitted directly to the supplementary medical insurance department after they are ready;

2. The staff of the supplementary medical insurance department will conduct a preliminary review of the information after receiving the information, and the audit results will be issued and signed after the review;

3. Then there will be a special person to review, if there is no problem with the review, they will enter the audit data into the computer, verify the reimbursement amount, and print the documents;

4. The documents will be passed to the relevant personnel, and then the fees will be reviewed, and there is no problem to sign directly on them;

5. After the signature is completed, the ** management office will start to handle the payment procedures on the same day, and the corresponding fees will be transferred to the corresponding bank account.

3. What cannot be reimbursed by supplementary medical insurance.

1. Purchased drugs and self-financed drugs that are difficult to travel outside the requirements of basic medical insurance;

2. The cost of the drug is inconsistent with the diagnosis certificate;

3. Non-emergency, medical expenses incurred in outpatient and inpatient departments outside designated medical institutions;

4. The expenses incurred do not meet or exceed the scope and standards of basic medical insurance reimbursement;

5. Medical expenses incurred due to medical accidents, traffic accidents, etc.;

6. Medical expenses incurred due to self-injury, suicide, alcoholism, etc.;

7. Medical expenses incurred due to drug abuse, fights and other illegal acts;

8. Medical expenses incurred due to receiving beauty, plastic surgery and other behaviors.

9. The expenses incurred shall be borne by the individual.

The content of how much can be reimbursed for medical insurance will be explained to everyone, everyone's situation is different, so the proportion of reimbursement 1 is not the same, and it has to be seen according to the actual situation.

The scope of reimbursement for supplementary medical mask key therapy includes self-financed drugs and purchased drugs other than the requirements of basic medical insurance; the cost of medicines that do not correspond to the diagnosis; All medical expenses for outpatient and inpatient treatment in non-designated medical institutions; Medical expenses that do not meet or exceed the scope and standards of basic medical insurance; All medical expenses caused by various liability accidents such as traffic accidents and medical accidents.

Article 28 of the Social Insurance Law.

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities, and emergency and rescue medical expenses shall be paid from the basic medical insurance in accordance with national regulations.

Article 29.

The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug blind and prudent product business unit.

The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.