1, hospitalization (including outpatient special treatment) medical expenses insurance is in the basic medical insurance catalogue. That is, the medical expenses incurred by the insured in the designated medical institutions of medical insurance due to diseases or accidents in the catalogue and the medical expenses for special outpatient treatment that meet the payment scope of basic medical insurance, after compensation by basic medical insurance, serious illness insurance and medical assistance, the deductible line is 6.5438+0.2 million yuan, the reimbursement ratio is 80%, and the annual payment limit is 6.5438+0.5 million yuan;
2, the basic medical insurance directory of hospitalization medical expenses insurance. That is, the necessary and reasonable medical expenses incurred by the insured in the designated medical institutions of medical insurance due to illness or accident are out of the basic medical insurance catalogue. The deductible line is 6.5438+0.8 million yuan, the reimbursement ratio is 60%, and the annual payment limit is 6.5438+0.5 million yuan;
3. Domestic specific drug cost insurance. The insured is diagnosed as having 19 kinds of major diseases and 36 kinds of diseases and indications corresponding to the domestic list of specific drugs by specialists in designated medical institutions of medical insurance, and enjoys the necessary and reasonable deductible line of specific drug expenses 18000 yuan, with 80% reimbursement rate and payment limit 150000 yuan. At the same time, for patients with previous diseases, the deductible is raised to 20,000 yuan, and the reimbursement ratio is reduced to 30%.
Shaanxi National Health Insurance Reimbursement Process:
1. Bring the original medical certificate and social security card to the social security center;
2. Fill in the reimbursement application form in the service window of the social security center and submit relevant materials;
3. The Social Security Center shall review the materials and submit them for reimbursement after approval;
4, patients get reimbursement or direct settlement of medical expenses.
To sum up, Shaanxi's "universal medical insurance" can be supplemented and reimbursed on the basis of medical insurance, mainly for reimbursement of major disease treatment expenses, covering both inside and outside medical insurance, aiming at reducing the economic burden brought by serious illness and serious illness to residents.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.