What is the reimbursement ratio of fracture medical insurance, and how much can fracture medical ins

Fracture. Medical insurance can reimburse about 70%. In general, rural cooperative medical insurance.

If you are hospitalized for more than three days and the medical expenses exceed 1,000 yuan, you can be reimbursed at 60 percent. Only urban workers can be reported for medical hospitalization, but generally not for outpatient services. The limit of examination fees and surgical fees for each visit is generally 50, and the limit for prescription drugs is usually 100 for secondary hospitals.

Thirty percent reimbursement is available for medical visits. The "Opinions on Determining the Scope and Payment Standards of Medical Service Facilities for Basic Medical Insurance for Urban Employees" stipulates that basic medical insurance medical service facilities refer to designated medical institutions.

provided. The prepayment ratio for fracture patients is generally between 70% and 80%, mainly depending on the prepayment ratio in each region, and is not formulated in the country. Taking the prepayment of up to 80% as an example, some equipment for fracture patients, such as steel plates, may not be able to enter the medical insurance, especially for export products, some projects need to have public funds, and some drugs cannot enter the medical insurance, so that the total prepayment is about 50% to 60%.

It depends on whether you go to a tertiary hospital or a community hospital, which is generally 85% and 90% in the community!

Medical insurance does not stipulate the insurance ratio for specific conditions such as fractures or appendicitis, and any disease is determined according to medication, surgery, etc.

Legal analysis: about 70% of the fracture medical insurance can be reimbursed. Under normal circumstances, the outpatient clinic of rural cooperative medical insurance can be reimbursed a little, and if the hospitalization exceeds three days, the medical expenses exceed 1,000 yuan, and the reimbursement can be given according to 60%.

Only urban workers can be reported for medical hospitalization, but generally not for outpatient services. The limit for each examination and surgery fee is generally 50 per visit, and the limit for prescription drugs is usually 100.

Legal basis: "Opinions on Determining the Scope and Payment Standards of Medical Service Facilities for Basic Medical Insurance for Urban Employees" Basic medical insurance medical service facilities refer to 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 and outpatient (emergency) observation bed fees.

Fracture surgery can be reimbursed by medical insurance for about 70%. Reimbursement process for medical insurance:

1. The handler submits the reimbursement documents and other materials to the social security institution for acceptance;

2. Since receiving the application materials, the acceptance department shall review, settle and pay the work;

3. If the social security institution approves the application, the applicant shall be reimbursed after receiving the reimbursement form for medical expenses of the social medical insurance. The medical insurance reimbursement process is relatively simple, and now the medical insurance cross-regional reimbursement has also been opened, and there is no need to go back and forth to reimburse the medical insurance for medical treatment.

Medical Insurance Reimbursement Coverage and Criteria:

1. Drugs are divided into Class A, Class B and Class C drugs, of which Class A drugs are clinically necessary and widely used, and the drug costs of such drugs are all reimbursed according to the proportion stipulated by the medical insurance. Class B drugs are paid a certain percentage by themselves, and then reimbursed according to medical insurance, and the specific reimbursement ratio is different according to the regulations of the medical insurance bureau in different places;

2. Diagnosis and treatment items refer to the medical instruments, equipment and medical materials used in the hospital for treatment, mainly in two ways, the full amount of reimbursement is included in the medical insurance reimbursement, and the payment is made in accordance with the prescribed proportion. For some co-ordinated projects, a part of the project is paid by oneself first, and then reimbursed according to the prescribed proportion;

3. The standard of medical service facilities refers to the fee for inpatient beds, outpatient and emergency beds, etc., and the reimbursement scope and standards are different in different places. If it is a medical insurance reimbursement scope in the social insurance, it is for the reimbursement of the items in the medical insurance catalog, including drugs, diagnosis and treatment items and medical service facilities.

Legal basisArticle 2 of the Social Insurance Law of the People's Republic of China.

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 ensure citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 28.

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

It depends:

1. Under normal circumstances, the hospitalization reimbursement ratio of fracture patients can reach up to 70% to 80%, and the reimbursement ratio varies from region to region.

2. The outpatient clinic of rural cooperative medical insurance can be reported a little, if the hospitalization is more than 3 days, the medical expenses exceed 1,000 yuan, and 60% can be reported.

3. Only urban employees can report for medical hospitalization, but generally not for outpatient treatment.

4. The examination fee and surgery fee limit for each visit is 50 yuan, and the prescription drug fee is limited to 100 yuan; 30% reimbursement for visits to secondary hospitals, 50 yuan for examination and surgery fees for each visit, and 200 yuan for prescription drugs.

The typical manifestations of fracture patients are local deformation after injury, abnormal movement of limbs, etc., and bone fricatives can be heard when moving limbs. In addition, the wound is severely painful, locally swollen, bruised, and there is movement disorder after the injury.

**The ultimate goal of a fracture is to maximize the recovery of the injured limb. 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.

Town medical reimbursement mainly refers to the hospital to see a doctor, medication, hospitalization, surgery, etc., can be reimbursed for medical expenses through the medical insurance card in accordance with the relevant regulations, urban medical insurance is more specific, the project scale and coverage is larger, but its compensation for major diseases or accidents is limited, it is recommended that the insured can purchase a combination of commercial serious illness medical supplementary insurance and social security to reduce their economic losses.

Legal basis: Opinions on the management of diagnosis and treatment projects of basic medical insurance for urban employees

Article 5. The labor and social security departments of the co-ordinating areas should strictly implement the catalogue of basic medical insurance diagnosis and treatment items in the province. For the basic medical insurance diagnosis and treatment items listed in the basic medical insurance catalogue of the province to pay part of the cost of the diagnosis and treatment items, the overall regional labor and social security administrative departments should be based on the actual local provisions of the specific individual self-payment ratio, and can be combined with regional health planning, hospital level and specialty characteristics, clinical indications, medical and technical personnel qualifications and other limited use and development of corresponding approval measures.

Large-scale medical equipment that is not included in the local regional health plan and unqualified technical testing in accordance with the relevant national quality management regulations shall not be included in the scope of basic medical insurance payment.

Seventh, the bustling bar.

The scope of diagnosis and treatment items of national basic medical insurance should be adjusted in a timely manner according to the ability to pay for basic medical insurance and the development of medical technology. The basic medical insurance diagnosis and treatment project catalogue of each province should be adjusted accordingly on the basis of the adjustment of the scope of the national medical insurance diagnosis and treatment project.

Summary. Because the accidental fracture is used in the county-level designated medical institutions, the part of the cost below 500 yuan will not be reimbursed, and 30% can be subsidized if it is more than 500 yuan to 2,000 yuan; 40% can be subsidized for more than 2,000 yuan to 5,000 yuan; 50% of the amount above 5000 years can be subsidized. Those who are hospitalized in a designated medical institution at or above the county level because of an accidental fracture.

Hospitalization expenses below 800 yuan will not be reimbursed; 20% of hospitalization expenses between 800 yuan and 2,000 yuan can be reimbursed; 30% of hospitalization expenses above 2,000 yuan to 5,000 yuan can be reimbursed; 40% of the hospitalization expenses above 5,000 yuan can be reimbursed.

Because the accidental fracture of the interception is used in the county-level designated medical institutions, the part of the cost below 500 yuan will not be reimbursed, and 30% can be subsidized if it is more than 500 yuan to 2,000 yuan; 40% can be subsidized for more than 2,000 yuan to 5,000 yuan; 50% of the amount above 5000 years can be subsidized. Hospitalization in a county-level designated medical institution due to accidental fracture of the balance. Hospitalization expenses below 800 yuan will not be reimbursed; 20% of hospitalization expenses between 800 yuan and 2,000 yuan can be reimbursed; 30% of hospitalization expenses above 2,000 yuan to 5,000 yuan can be reimbursed; 40% of the hospitalization expenses above 5,000 yuan can be reimbursed.

Divided into these two, I hope it will help you and wish you a happy life.

Is it an accidental injury to fall while riding a tricycle?

It is an accidental injury, and if it occurs during the commute to and from work, you can generally claim compensation for work-related injuries.

How much can I reimburse for the more than 30,000 yuan spent on a fracture hospitalization?

You can refer to the above, which one you belong to.

After all, this can only be used as a reference.

It also needs to be subject to the actual situation.