Is Trauma Medicare Reimbursable? Is it covered by medical insurance for trauma

It cannot be said in general terms that trauma is not reimbursable, but only within the prescribed scope. Those who meet the prescribed conditions can be reimbursed.

According to the relevant provisions of the state's medical insurance: self-medical treatment (no designated hospital for medical treatment or no referral form), self-purchased drugs, drugs that cannot be reimbursed by publicly-funded medical regulations and medical expenses that do not meet the requirements of family planning; Outpatient fees, house visit fees, hospitalization fees, food expenses, accompanying fees, nutrition fees, and blood transfusion fees (except for those with family blood storage, which will be reimbursed according to relevant regulations).

Other expenses such as heating and cooling expenses, ambulance expenses, special care expenses, etc.; medical expenses for car accidents, fights, suicides, alcoholism, work-related accidents, and medical malpractice; Orthopedics, plastic surgery, dental prosthesis, prosthesis, organ transplantation, roll call surgery fees, consultation fees, etc., are not covered by the limit. None of them are covered by medical insurance.

Trauma is to see how you are injured, if there is a third party responsible for the medical insurance can not be reimbursed, if there is no third party responsible, medical insurance can be reimbursed, but you need to provide medical records and other materials, the medical insurance department needs to check.

Can trauma medical insurance reimburse, it should be possible, because there will still be this and that kind of illness outside the human body, and what or the cause of the disease on the limbs may occur, which is also a condition of trauma. It is also outside the body, and it is still within the scope.

Legal analysis: If there is no third party liability for the trauma, the medical insurance can reimburse it. Legal basis:

Article 30 of the Social Insurance Law of the People's Republic of China The following medical expenses are not included in the scope of payment of basic medical insurance**: (1) shall be paid from work-related injury insurance**; (2) It shall be borne by a third party; (3) It shall be borne by public health; (4) Seeking medical treatment outside the country. Medical expenses shall be borne by a third party in accordance with law, and the third party shall not pay or cannot be confirmed".

1.should be paid out of work-related injury insurance**.

2.It shall be borne by a third party.

3.should be borne by public health.

4.Those who seek medical treatment outside of China.

5.Sports and fitness, health care consumption, health check-up.

6.Other expenses not covered by the basic medical insurance** stipulated by the state.

Self-medical treatment (no designated hospital or no referral form), self-purchased drugs, drugs that cannot be reimbursed by publicly-funded medical regulations, and medical expenses that do not comply with family planning; Outpatient fees, house visit fees, hospitalization fees, food expenses, accompanying fees, nutrition expenses, blood transfusion fees (except for those with family blood storage, which will be reimbursed according to relevant regulations), air-conditioning and heating fees, ambulance fees, special care fees and other expenses; medical expenses for car accidents, fights, suicides, alcoholism, work-related accidents, and medical malpractice; Orthopedics, plastic surgery, dental prosthesis, prosthesis, organ transplantation, roll call surgery fees, consultation fees, etc., are not covered by the limit. None of them are covered by medical insurance.

Therefore, it cannot be said in general terms that trauma is not reimbursable, but only within the prescribed scope. Those who meet the prescribed conditions can be reimbursed.

Medical insurance reimbursement and subsidy coverage:

1. Outpatient and emergency medical expenses: the part of the medical expenses that meet the scope of basic medical insurance in the year of in-service employees exceeds the prescribed amount by 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel more than 2,000 yuan during the contract period, and 50% of the personal payment; The maximum amount of reimbursement for outpatient and emergency treatment of dispatched personnel in a year is 20,000 yuan.

3. The insured person should properly keep the outpatient medical documents (including receipts and prescriptions for the following parts) in the designated hospital as the medical expense reimbursement voucher.

4. Outpatient treatment for three special diseases: the insured person needs to seek medical treatment in the outpatient clinic when he or she suffers from radiation and chemical treatment of malignant tumors, kidney dialysis, and anti-rejection drugs after kidney transplantation.

2. The designated hospital shall issue a "Disease Diagnosis Certificate" and fill in the "Application and Approval Form for Special Diseases of Medical Insurance" and submit it to the District Medical Insurance Center for approval and filing. Outpatient treatment and medicine collection for these three special diseases can only be purchased at designated hospitals approved for treatment, and cannot be purchased at designated retail pharmacies. If the medical expenses incurred meet the scope of outpatient special diseases, they shall be settled with reference to hospitalization.

5. Inpatient medical treatment.

Legal analysis: If the trauma is caused during the work process or on the way to and from work, the social security work-related injury insurance will reimburse it in accordance with the prescribed methods; If the trauma is caused in everyday life, social security medical care will not be reimbursed. Those who seek medical treatment in a medical institution that is not designated by the person, except for emergency treatment; Purchasing drugs at non-designated retail pharmacies; Injuries caused by traffic accidents, medical accidents or other liability accidents; Injury caused by drug use, fighting, or other illegal acts; Committed due to suicide, self-harm, alcoholism, etc.; In foreign countries or in Hong Kong, Macao Special Administrative Region and Taiwan**; In accordance with the provisions of the state and the city, it shall be paid by the individual.

Legal basis: "Social Insurance Law of the People's Republic of China" Article 38 The following expenses incurred due to work-related injuries shall be paid from work-related injury insurance in accordance with national regulations: (1) medical expenses and expenses for work-related injuries; (2) Subsidies for in-hospital meals; (3) Transportation and lodging expenses for medical treatment outside the overall planning area; (4) The cost of installing and configuring assistive devices for the disabled; (5) For those who are unable to take care of themselves, the living care expenses confirmed by the Labor Ability Appraisal Committee; (6) A one-time disability subsidy and a monthly disability allowance for disabled employees of grades 1 to 4; (7) A one-time medical subsidy to be enjoyed when the labor contract is terminated or dissolved; (8) In the event of a work-related death, the surviving family members shall receive the funeral subsidy, the pension for dependent relatives and the work-related death subsidy; (9) Labor ability appraisal fee.

Answer: Article 24 of the Social Insurance Law of the People's Republic of China: The State shall establish and improve a new type of rural cooperative medical system. The management measures for the new type of rural cooperative medical care shall be stipulated by ***. Article 25 of the Social Insurance Law of the People's Republic of China The State shall establish and improve the basic medical insurance system for urban residents.

The basic medical insurance for urban residents implements a combination of individual payment and subsidy. The part of the personal contributions required by those who are subject to the minimum living guarantee, the disabled who have lost the ability to work, the elderly over the age of 60 and minors from low-income families, etc., will be subsidized by **.

For traumatic injuries caused by oneself accidentally, the doctor shall indicate on the medical record that he was accidentally injured and the process of injury, and the medical insurance center can reimburse the trauma, and if the medical insurance center does not reimburse the trauma, car accident, and other responsible injuries caused by others, the cost shall be borne by the responsible person.

Reimbursement. As long as you are not injured by someone else, you can be reimbursed.

Trauma is subject to filing.

For medical insurance reimbursement, the exclusion of third-party liability and intentional and criminal acts is restricted.

In your case, if you are injured at home, you are eligible for medical insurance reimbursement.

As long as you participate in medical insurance, as long as you go to the hospital to see a doctor, you can be reimbursed.

Legal analysis: If there is no third party liability for the trauma, the medical insurance can reimburse it.

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 **.

Legal analysis: If there is no third party liability for the trauma, the medical insurance can reimburse it.

Legal basis: Article 30 of the Social Insurance Law of the People's Republic of China 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 shall 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.