What is the reimbursement scope of the medical insurance card? What is the reimbursement scope of th

Medical Insurance Reimbursement Coverage:The types of drugs in China can be mainly divided into class A, class B and class C, and the waist circumference of class A is basically included in the scope of medical insurance **, and reimbursement is given according to certain standards; 80% reimbursement for Class B drugs, and the other 20% are self-paying; Category C drugs are self-financing drugs and will not be reimbursed.

The following drugs are not covered by the basic medical insurance: (1) drugs that mainly play a nutritional tonic role;

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);

Reimbursement of the medical insurance card is limited to medical expenses incurred in the designated hospital due to illness or some accidents. The reimbursement formula is: (total expenses - threshold fee - out-of-pocket expenses - overrun expenses) (75 years old) Under normal circumstances, the actual reimbursement ratio is 20% 60%.

Self-financed drugs are not reimbursed, 80% of Class B drugs are reimbursed, there is a limit on bed fees, and some examination fees and diagnosis and treatment fees cannot be reimbursed according to regulations. Article 28 of the Social Insurance Law of the People's Republic of China shall be paid from the basic medical insurance in accordance with the provisions of the basic medical insurance for the drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses.

Legal analysis: medical insurance reimbursement scope: meet the standards of basic medical insurance drug catalog, diagnosis and treatment items, medical service facilities, and emergency medical expenses.

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

Article 23 Employees shall participate in the basic medical insurance for employees, and the employer and the employees shall jointly pay the basic medical insurance premiums in accordance with the provisions of the State.

Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

1. The reimbursement of the medical insurance card is limited to the leakage of medical expenses above hospitalization caused by illness and some accidents in designated hospitals;

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 in designated pharmacies, but it does not belong to the scope of reimbursement, because the money in the medical insurance card is the money in the personal account of medical insurance;

4. Reimbursement of serious illness insurance, after the insured person suffers from a serious illness, the part of the personal self-responsibility that occurs in the designated medical institutions of the city's 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 50% of the insurance funds will be reimbursed by the serious illness return insurance funds.

1. The reimbursement of the medical insurance card is limited to the medical expenses above hospitalization caused by illness and some accidents in designated hospitals. The reimbursement formula is: (total cost - threshold fee - out-of-pocket - overrun expenses) * (75 + age *, under normal circumstances, the actual reimbursement ratio varies from 20 to 60%.

Self-financed drugs are not reimbursed, 80% of Class B drugs are reimbursed, there is a limit on bed fees, and some examination fees and diagnosis and treatment fees 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 in designated pharmacies, but it does not belong to the scope of reimbursement, because the money in the medical insurance card is the money in the personal account of medical insurance;

4. Reimbursement of critical illness insurance. After the insured person suffers from a serious illness, the personal self-responsibility part that occurs in the designated medical institutions of the city's medical insurance and meets the requirements of the city's medical insurance shall be included in the payment scope of the residents' serious illness insurance, and 50% will be reimbursed by the serious illness insurance funds. i.e., reimbursement amount = 50% of the deductible.

The main purpose of medical insurance is to pay for outpatient and inpatient medical treatment, in addition, you can also buy medicines at designated pharmacies, use medical equipment, thermometers and blood pressure monitors, and pay for self-paid items such as physical examinations. The medical insurance card must not be borrowed, nor can it be abused. The medical insurance card can only be used by the cardholder and cannot be rented or lent.

Legal Analysis: The reimbursement of the medical insurance card is limited to the medical expenses above hospitalization caused by illness and some accidents in designated hospitals. The reimbursement formula is:

Total Expenses - Threshold Fee - Self-Pay - Overrun Expenses) (75 years old) Under normal circumstances, the actual reimbursement rate is 20% to 60%. Self-financed drugs are not reimbursed, 80% of Class B drugs are reimbursed, there is a limit on bed fees, and some examination fees and diagnosis and treatment fees cannot be reimbursed according to regulations. The reimbursement amount of the medical insurance card is 4 times the average salary of local social workers (the cumulative value in 1 year). The money in the medical insurance card can be used to buy medicines and pay for outpatient and emergency expenses at designated pharmacies, but it is not included in the reimbursement category, because the money in the medical insurance card is the money in the medical insurance personal account; After the insured person suffers from a serious illness, the part of the personal self-payment that occurs in the designated medical institutions of the city's 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 50% of the reimbursement amount shall be reimbursed by the serious illness insurance funds, that is, 50% of the reimbursement amount.

Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China Article 28 Medical expenses that meet the standards of basic medical insurance drug lists, diagnosis and treatment items, medical service facilities, and emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations.