What is the scope of medical insurance reimbursement inside the social security?

The scope of reimbursement of medical insurance meets the scope of medical expenses paid by the basic medical insurance fund, and is reimbursed in accordance with the basic medical insurance drug catalog, diagnostic and treatment item catalog, as well as the scope of services and facilities and payment standards stipulated by the city.

Currently, the price of national health insurance drugs has changed, see here: "2020 national health insurance drug catalog latest out! The drugs you buy are going to have their prices reduced!

What are the situations in which Social Security does not reimburse?

1, maternity insurance is not reimbursed in the following cases:

1) Expenses incurred to go abroad or to Hong Kong, Macao and Taiwan to give birth to a child are not reimbursed.

2) Reimbursement will not be reimbursed even if you go beyond the stipulated reimbursement period.

3) Reimbursement will not be made if you have paid maternity insurance for less than one year, or if your maternity insurance has been suspended at the time of delivery.

4) Reimbursement will not be made if the documents required for reimbursement are incomplete.

2, medical insurance does not reimburse the situation:

Medicare is the social security reimbursement of the highest rate of use, so whether it is reimbursement or reimbursement scope, the restrictions are also more.

Simply put, Medicare reimbursement limitations, including two fixed points, three catalogs, starting line, cap line, reimbursement rate, cap line and so on.

In addition, the following special circumstances, health insurance is not reimbursed.

Self-medical treatment

For example, not going to a designated hospital, or not following the requirements of the referral form.

Charges for services during treatment

such as consultation fees, food costs, nutritional costs, blood transfusion fees, and heating and cooling fees.

Medical bills arising from intentional injuries

Medical bills arising from car accidents, fights, and alcoholism.

Orthopedics, cosmetic surgery, dentures, prosthetics, organ transplants, named surgery fees, consultation fees, etc.;

Costs that should be paid out of the Workers' Compensation Insurance and Maternity Insurance Funds.

Medical expenses that should be borne by a third party.

The milkman concluded that as long as the conditions allow, in addition to medical insurance, we had better configure a commercial insurance, to give themselves and their families to add a firewall.