Current location - Music Encyclopedia - QQ Music - What are the scope of medical insurance reimbursement in social security?
What are the scope of medical insurance reimbursement in social security?
the reimbursement scope of medical insurance is in line with the payment scope of the basic medical insurance fund, and the medical expenses shall be reimbursed according to the list of basic medical insurance drugs, the list of diagnosis and treatment items, the scope of service facilities and the payment standard stipulated by this municipality.

At present, the prices of national medical insurance drugs have changed. Please see here: The National Medical Insurance Drug List in 22 is newly released! The medicine you bought will be reduced in price!

what are the situations in which social security is not reimbursed?

1. Maternity insurance is not reimbursed:

1) Expenses incurred in going abroad or having children in Hong Kong, Macao and Taiwan are not reimbursed.

2) Reimbursement will not be made after the prescribed reimbursement period.

3) if the maternity insurance has not been paid for one year, or the maternity insurance has been stopped at the time of production, it will not be reimbursed.

4) if the materials required for reimbursement are incomplete, it will not be reimbursed.

2. Non-reimbursement of medical insurance:

Medical insurance has the highest utilization rate in social security reimbursement, so there are more restrictions in terms of reimbursement amount and scope.

In short, the medical insurance reimbursement limits include two fixed points, three directories, deductible line, capping line, reimbursement ratio, capping line, etc.

in addition, medical insurance is not reimbursed under the following special circumstances.

Seek medical treatment by yourself

For example, you don't go to the designated hospital for medical treatment, or you don't handle the referral form as required.

service charges during treatment

such as visiting fees, meals, nutrition fees, blood transfusion fees, cooling and heating fees, etc.

medical expenses caused by intentional injury

medical expenses caused by car accidents, fights, alcoholism and other reasons.

Orthopedics, plastic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consultation fees, etc.

expenses that should be paid from work-related injury insurance and maternity insurance funds.

medical expenses that should be borne by the third party.

Dad concluded that, as long as conditions permit, apart from medical insurance, everyone had better configure a commercial insurance to add a firewall to themselves and their families.