What expenses can be reimbursed by medical insurance, and what expenses can be reimbursed by medical

Recommend "Big Special Medical Insurance" medical insurance. This "big special medical insurance" can be reimbursed for all kinds of hospitalization expenses or outpatient and emergency expenses due to accidents or diseases, and the general insurance refers to a certain aspect, or the insurance amount is low, and the categories that can be reimbursed are more reimbursable, but the "big special medical insurance" covers almost all your expenses in the hospital, and if you seek medical treatment in other cities, you can also report, there are no restrictions on drugs, and the national joint insurance.

There are two versions of the insurance amount of "big special medical insurance" of 200,000 yuan and 500,000 yuan, including various expenses incurred in outpatient and emergency services and specific outpatient services before and after hospitalization, and the reimbursement scope includes drug fees, inpatient surgery fees, bed fees and meal fees, and other expenses, and the daily limit of bed fees and meals is 2,000 yuan; Ordinary outpatient and emergency is optional, with an insurance amount of 1,000 yuan and no deductible, which can meet the high-frequency medical needs of daily minor diseases, and the reimbursement scope covers diagnosis and treatment fees, examination fees, ** fees, outpatient surgery fees, drug fees, physical ** fees, etc.

"Big special medical insurance" has also added two additional services: expert consultation and health consultation, provided by a third-party medical and health institution, for some small colds or something, no need to go to the hospital, you really don't feel at ease you can consult an expert, it is very convenient, and it has reached the standard of high-end medical insurance services.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

Medical insurance is basically reimbursable, and reimbursement expenses can be understood in this way, you know.

According to the provisions of the Social Insurance Law: the medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations.

1. Generally speaking, ordinary medical expenses can be reimbursed, but some imported drugs and complex diseases cannot be reimbursed. When paying in the hospital, the amount marked "self-pay one" under the bill can be reimbursed, but "tariff", "self-payment two" and other expenses cannot be reimbursed.

2. The reimbursement of basic medical service facilities covers the life service facilities provided by designated medical institutions, and the insured persons must be in the process of receiving diagnosis, ** and nursing: inpatient bed fees, outpatient (emergency) observation bed fees, etc., but the cost of life service items and service facilities such as transportation expenses and ambulance fees are not reimbursable.

Hello Answer! We're happy to answer for you! 1. General medical insurance includes outpatient expenses, medical expenses, examination costs, etc. 2. Hospitalization insurance daily hospitalization expenses, the cost of using hospital equipment, surgical expenses, medical expenses, etc. 3. Surgical insurance provides all expenses incurred due to the patient's need to do necessary surgery 4. The scope of comprehensive medical insurance costs includes all expenses such as medical treatment and hospitalization and surgery

Social Insurance Law of the People's Republic of China Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be settled directly by the social insurance agency and the medical institutions and drug business units. 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. Hope it helps!

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The expenses that can be reimbursed by medical insurance mainly include drug costs, diagnosis and treatment project costs and service facility costs.

1. The cost of basic medical drugs: the drug costs that can be reimbursed by medical insurance include class A and class B, class A drugs are unified across the country to ensure the basic requirements of clinical **, and the list of class B drugs is adjusted by each region;

2. Expenses for basic medical diagnosis and treatment items: hemodialysis, bone marrow transplantation and other diagnosis and treatment items within the scope of basic medical insurance diagnosis and treatment items;

3. Expenses for basic medical service facilities: the expenses incurred by the insured persons in the process of diagnosis** and nursing in designated medical institutions.

As long as the cost of hospitalization is reimbursable, including the cost of examination and medicine for hospitalization. If you can't reimburse the cost, the doctor will tell you that the drug can't be reimbursed, and it's up to you to decide whether it is a self-paid drug or not.

What is Medicare Coverage? When reimbursement, many people don't understand why some drugs can be reimbursed, but some drugs are not reimbursed, especially wonder why others can reimburse the same medical insurance for drugs that they can't reimburse. It also brings joy or sorrow to different insured people.

Therefore, we have a comprehensive understanding of the reimbursement scope of medical insurance, medical insurance is fair to everyone, and whether we can enjoy the benefits it brings us depends on whether we are familiar with the "rules of the game".

Medical insurance can reimburse hospitalization expenses and medical expenses.

Within the scope of the medical insurance reimbursement catalog.

The expenses that can be reimbursed by medical insurance are:

1. Medical expenses during the rescue period.

2. Medical expenses during hospitalization.

3. Hand straw materials and auxiliary equipment.

4. Bed fee.

5. **Physiotherapy fee.

6. Dressing change and functional guidance training.

7. Ambulance fee.

8. Renewal medical expenses.

Medical Insurance Reimbursement Notes:

1. Note that there are designated institutions for medical treatment and medical insurance in designated institutions. When you are insured, you must remember that your designated hospital is **, and only when you go to the designated hospital to see a doctor and be hospitalized can you be reimbursed; If you go to a non-designated medical institution, you can't reimburse the ** expense, so you can only bear it yourself.

2. Don't transfer to another hospital without permissionIf you have some diseases and can't see them in designated medical institutions, you have to go to a better hospital**, you have to apply for a referral first, and the referral with complete procedures can be reimbursed; If you don't apply for a referral, it's still equivalent to going to a designated medical institution that you didn't choose, and you still can't get reimbursed.

3. The medical insurance has a minimum payment line to apply for medical insurance, and only after the money you pay first reaches that amount, you can be reimbursed.

4. Some drugs that cannot be reimbursed by medical insurance are specific, and only drugs in the medical insurance catalog can be reimbursed, while drugs outside the medical insurance catalog cannot be reimbursed, such as many imported innovative drugs and patented drugs. Therefore, communicate with the doctor before taking the drug, and if you want to save money, you should use the drugs in the catalog.

What does Medicare cover?

1. Reimbursement of drugs for basic medical insurance.

The drugs included in the scope of basic medical insurance are divided into two types: Class A and Class B. Class A drugs refer to drugs that are basically unified across the country and can ensure the basic needs of clinical practice. The cost of such drugs is included in the scope of basic medical insurance** and is paid according to the standard of basic medical insurance.

The list of Class B drugs is adjusted by the provinces, autonomous regions and municipalities directly under the Central Government according to their own conditions, and such drugs are first paid by employees for a certain percentage of the cost, and then included in the scope of basic medical insurance, and paid according to the standard of basic medical insurance.

The following drugs are not covered by the basic medical insurance:

1) Drugs that mainly play a role in nutrition and nourishment;

2) Some animals and animal organs, dried (water) fruits that can be used for medicine;

3) All kinds of liquor preparations brewed with Chinese herbal medicines and Chinese herbal decoction pieces;

4) Fruit-flavored preparations and oral effervescent agents in various drugs;

5) Blood products and protein products (except for special indications, first aid and rescue);

6) Other drugs that are not paid by the basic medical insurance according to the social insurance administrative department.

2. Reimbursement of basic medical insurance diagnosis and treatment items.

The basic medical insurance diagnosis and treatment items shall meet the following conditions:

1) Clinical diagnosis and treatment is necessary, safe and effective, and the cost is appropriate;

2) The price department has set the charging standard;

3) Within the scope of designated medical services provided by designated medical institutions for insured persons.

The scope of diagnosis and treatment items paid by basic medical insurance is determined in accordance with the scope of diagnosis and treatment items of basic medical insurance stipulated by the state. Belong to the basic medical insurance to pay part of the cost of the diagnosis and treatment items within the catalog, by the insured according to the prescribed proportion of self-payment, and then according to the provisions of the basic medical insurance payment. If it is within the list of diagnosis and treatment items that are not paid by the basic medical insurance for employees, the basic medical insurance for employees will not be paid.

3. Reimbursement for basic medical service facilities.

The reimbursement of medical service facility expenses of basic medical insurance covers the life service facilities provided by designated medical institutions and necessary for insured persons in the process of receiving diagnosis, ** and nursing, mainly including inpatient bed fees or outpatient (emergency) observation bed fees.

The basic medical insurance** does not pay for the cost of life services and service facilities, mainly including:

1) Transportation expenses and ambulance expenses for medical treatment;

2) Air conditioning fee, TV fee, ** fee, baby incubator fee, food incubator fee;

3) Escort fee, nurse fee, washing fee, outpatient decoction fee;

4) Meal expenses;

5) Recreational activities and other special living services.

Ambulance expenses are not covered by medical insurance. If an insured person is sent to the hospital by an ambulance due to a sudden illness, the pre-hospital emergency expenses incurred by the patient in the car can be reimbursed sporadically, but the ambulance fare is not covered by the medical insurance. The ambulance expenses that meet the requirements of the drug fees, examination fees, laboratory fees, oxygen inhalation fees, ** fees, rescue fees, etc., can be reimbursed according to the hospitalization treatment together with the emergency hospital observation and medical expenses.

Ambulance fares are classified as Class C and are not reimbursed. However, if it is a retired cadre, according to the regulations, when an ambulance is called to be sent to the hospital for emergency or serious illness, the ambulance fee will be reimbursed by the original work unit. Reimbursement Steps:

1. When applying for reimbursement, you need to bring your ID card (if you entrust others to do it, you also need to provide the agent's valid certificate), social security card or medical insurance card, "Medical Record Book", original receipts of medical expenses, relevant medical history materials and copies, and apply for sporadic reimbursement at the nearest district and county medical insurance center or street medical insurance service point within 6 months from the date of issuance of the medical fee receipt. 2. The insured personnel of the units directly under the city should apply for sporadic reimbursement at the Municipal Medical Insurance Affairs Center. The ambulance is a special vehicle, and it can run a red light on the premise of ensuring safety when performing emergency tasks.

Questions. Rural medical car accident report.

Accidental car accidents are expenses borne by a third party and are not covered by rural cooperative medical reimbursement. Only if the perpetrator does not pay or the perpetrator cannot be determined, the new home will pay in advance according to the prescribed proportion; The following medical expenses are not included in the scope of NCMS** payment: 1. Those that should be borne by public health; 2. It should be paid from work-related injury insurance**; 3. It should be borne by a third party; 4. Caused by intentional crime, alcoholism, drug abuse, suicide, self-harm, brawl, etc.; 5. Seeking medical treatment abroad; 6. Exceeding the scope of the list of essential drugs, basic diagnosis and treatment items and medical service facilities for reimbursement by NCMS.

The medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the NCMS shall pay in advance according to the prescribed proportion. NCMS** has the right to recover from a third party after paying in advance.

1. General outpatient examination fees, expert outpatient consultation fees, and emergency consultation fees of medical institutions that meet the regulations;

2. Bed fees for ordinary wards in designated medical institutions;

3. Outpatient decoction fee;

4. Medical expenses incurred in medical treatment and dispensing in designated medical institutions or dispensing in designated retail pharmacies;

5. Medical expenses that meet the diagnosis and treatment items, medical service facilities, drug scope and payment standards of basic medical insurance.

Introduction to Medicare. Medical insurance refers to social medical insurance. Medical insurance is a law and regulation formulated by the state and ** according to social practice, which provides the most basic medical needs for workers participating in the insurance during their illness.

The basic medical insurance** is composed of the overall plan** and the personal account, and all the medical premiums paid by the employees are remitted to the personal account; Part of the medical premiums paid by the employer for the employee are remitted to the personal account, and part of the medical premiums are remitted to the overall plan**.

Medical Insurance Reimbursement Ratio:

1. Outpatient and emergency medical expenses: the part of the medical expenses of employees that meet the scope of medical insurance regulations within one consecutive year reaches more than 2,000 yuan;

2. Settlement ratio: 50% of the part of the dispatched personnel exceeding 2,000 yuan during the contract period will be reimbursed, and the remaining 50% will be borne by the individual; The maximum reimbursement limit for outpatient and emergency treatment of dispatched personnel within one consecutive year is 20,000 yuan;

3. The insured person must keep the medical documents of the designated medical institutions as the voucher for reimbursement;

4. Outpatient treatment of three special diseases: when the insured person suffers from malignant tumor radiation ** and chemical **, kidney dialysis, and anti-rejection drugs after kidney transplantation and needs to seek medical treatment in the outpatient clinic, he must ask the hospital to issue a "disease diagnosis certificate", and fill in the "Medical Insurance Special Disease Declaration and Approval Form", and report to the local medical insurance center for approval and filing. These three special diseases must be diagnosed and ** in a designated hospital before they can be settled.

The reimbursement is mainly for some medications, and some hospitalization expenses can also be reimbursed, as well as the cost of surgery can be reimbursed by medical insurance.