What is the difference between a fall at home and a fall outside?

Falls at home will inevitably be reimbursed by medical insurance, while falls outside must be reasonably analyzed according to different situations. Here's a detailed explanation of this issue:

1.If you fall on your own, you can be reimbursed by cooperative medical care. Opinions and suggestions: the proportion is between 20% and 60%, and the reimbursement ratio of trauma hospitalization is different in various places, mainly because the reimbursement ratio is different for different levels of hospitals, usually the higher the level, the lower the reimbursement ratio.

2.The reimbursement items of basic medical insurance for falling injuries outside should meet the following conditions: (1) clinical diagnosis and treatment are necessary, safe and effective, and the cost is appropriate; (2) The price department has formulated 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.

3.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 business unit. The administrative departments for social insurance and health shall establish medical treatment in other places.

Within the scope of reimbursement:

1.self-purchased drug fees;

2.Beyond the "Provincial New Rural Cooperative Medical Care".

the cost of medicines under the Essential Medicines List;

3.**Fees, outpatient medical records.

Cost of work, house visit fee, Chinese medicine decoction fee, ambulance fee, escort bed fee, bed charter fee, special care fee, consultation fee, air conditioning (including heating) fee, TV fee, ** fee, personal living expenses, nursing fee, etc.; Non-basic medical care (refers to special outpatient services.

Specialist outpatient clinics, bed fees of more than 35 yuan per day, medical cosmetology, family beds, etc.);

4.Fighting, drinking.

Drug abuse, drug rehabilitation, sexually transmitted diseases.

Work-related injuries and injuries sustained in the course of labor, traffic accidents, intentional self-injury, non-productive pesticide poisoning, occupational poisoning, and medical accidents.

Medical expenses caused by violations of laws and disciplines and other people's reasons; abortion induction;

5.All kinds of plastic surgery, orthopedics, **, correction of physiological defects and various health care, preventive diagnosis and treatment items and drug costs; 6.the cost of purchasing organs or tissues for organ or tissue transplantation or installation of artificial organs;

7.Medical services, examinations, ** items that are not approved by the price and health authorities, as well as all expenses incurred by inflating the fee standard without authorization; There are fraudulent medical expenses such as non-hospitalization or impersonation hospitalization;

8.It has obtained basic medical insurance for urban employees.

and basic medical insurance compensation for urban residents and other basic medical insurance compensation; medical expenses incurred abroad; Other provisions of the new type of rural cooperative medical care.

Falls at home can definitely be reimbursed by medical insurance, and falls outside may depend on the specific cause, time, etc., such as work-related injury insurance during working hours, and traffic compensation if it is caused by a traffic accident, so it is necessary to analyze the specific problem on a case-by-case basis.

Legal analysis: can be reimbursed, 1. The reimbursement of the medical insurance card is limited to the medical expenses above the hospitalization caused by illness and some accidents in the designated hospital. The reimbursement formula is:

Total Expenses - Threshold Fees - Out-of-pocket Expenses - Overrun Expenses) (75 years old, under normal circumstances, the actual reimbursement ratio varies from 20 to 60.) Self-financed drugs are not reimbursed, Class B drugs are reimbursed 80, there is a limit on bed fees, and some examination fees and diagnosis and treatment fees according to the regulations cannot be reimbursed.

2. The reimbursement amount of the medical insurance card is 4 times the average salary of local social workers (the cumulative value within 1 year).

3. The money in the medical insurance card can be used to buy drugs and pay for outpatient and emergency expenses at designated pharmacies, but it does not belong to the reimbursement category, because the money in the medical insurance card is the money in the medical insurance personal account.

4. After the insured person is reimbursed by the critical illness insurance, the personal self-responsibility part that occurs in the designated medical institutions of the municipal medical insurance and meets the provisions of the city's medical insurance shall be included in the payment scope of the residents' serious illness insurance and shall be reimbursed by the serious illness insurance funds50. That is, the reimbursement amount is deductible 50

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 **.

Medical insurance can be reimbursed, but if you fall and are injured by work, you can't be reimbursed.

Scope of non-reimbursement by medical insurance:

Social Insurance Law of the People's Republic of China

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Seeking medical treatment outside the country.

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 basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

Cases in which work-related injuries are not reimbursed:

Social Insurance Law of the People's Republic of China

Article 37 If an employee is at work due to any of the following circumstances, it shall not be deemed to be a work-related injury:

1) Intentional crime;

2) Drunkenness or drug abuse;

3) self-harm or suicide;

4) Other circumstances provided for by laws and administrative regulations.

What is covered by medical insurance:

Social Insurance Law of the People's Republic of China

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 **.

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 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.

Hospitalization for surgery for traumatic injuries caused by falling on a bicycle is an accidental fall and is covered by medical insurance. However, in order to be reimbursed, you must have been insured before you were injured and that you had a full set of procedures for hospitalization** after your injury.

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

Can medical insurance reimburse me for my own fall? What to look out for?

Can medical insurance reimburse injuries caused by traffic accidents?

Traffic accidents and other accidents involving a third party, or suicide, drug abuse, drunkenness, fights and other illegal and criminal circumstances, medical insurance will not reimburse, while other accidents can basically be reimbursed. When reimbursement is required for falls, bleeding, fractures, burns and other reasons, the public security or transportation department shall issue a certificate of trauma to prove that the patient has no facts of violating the law or committing a crime and that there is no third-party responsible person.

Summary. Hello, one is the total cost in addition to the self-pay part, class B expenses first pay 10%, more than the hospital medical insurance threshold part, enjoy the overall payment ratio of different levels of different threshold fees, enjoy the proportion of overall payment is also different, the proportion of employee medical insurance is 80%, the proportion of domestic medical insurance is about 70%, the social supplementary medical insurance for retirees under the age of 70 is 50%, and all the reimbursement ratios are above the starting line to be reimbursed. Falls at home can definitely be reimbursed by medical insurance, and falls outside may depend on the specific cause, time, etc., such as work-related injury insurance during working hours, and traffic compensation if it is caused by a traffic accident.

Hello, there is no difference between falling at home and falling outside medical insurance reimbursement, falling at home and falling outside accidental fall injury in the implementation of reimbursement is in accordance with a certain proportion of reimbursement, this reimbursement ratio is mainly divided into the following situations: a kind of slag Xun is a different file of the hospital only medical insurance such as stupid this reimbursement ratio is different, incumbents report 80%, retired or unemployed, unemployed 50%;

Hello, one is the total cost in addition to the leakage of Zheng Fei part, Class B expenses first pay 10%, more than the hospital medical insurance threshold part, enjoy the overall payment ratio of different levels of different threshold fees, enjoy the proportion of overall payment is also different, the proportion of employee medical insurance is 80%, the proportion of domestic medical insurance is only about 70%, retirees under the age of 70 social refers to Sochang supplementary medical insurance is 50%, all reimbursement ratios are above the starting line to reimburse. Falls at home can definitely be reimbursed by medical insurance, and falls outside may depend on the specific cause, time, etc., such as work-related injury insurance during working hours, and traffic compensation if it is caused by a traffic accident.

Falling at home is more expensive than falling outside.

Hello dear, it's the same.

Summary. What is the difference between a fall at home and a fall outside?

As shown in the picture, I hope mine can help you, do you have any other questions? If you are satisfied, please give a thumbs up, this is very important to me, thank you, I wish you a happy life.

Injured in a fall on a battery bike.

Injured in a fall on a battery bike.

It's the same.