There are many types of medical insurance in China, basically buy medical insurance will be issued medical insurance card, the participants in the medical treatment will be able to show the medical insurance card for reimbursement.
One, how to reimburse the proportion of foreign medical insurance card
The cross-provincial medical insurance treatment in accordance with the implementation of the directory of the place of residence, mainly including the basic medical insurance drug catalog, diagnostic and therapeutic items and medical service facilities standards.
Secondly, what is the reimbursement rate of urban residents' medical insurance
The starting standard and reimbursement rate of urban residents' basic medical insurance are determined according to the categories of the insured persons with different standards.
1. Students and children. For medical expenses under 180,000 RMB incurred within a settlement year that are eligible for reimbursement, the starting standard for Level III hospitals is 500 RMB and the reimbursement rate is 55%; the starting standard for Level II hospitals is 300 RMB and the reimbursement rate is 60%; and Level I hospitals do not have a starting standard and the reimbursement rate is 65%.
2. Elderly people over 70 years old. For medical expenses under 100,000 RMB that are eligible for reimbursement in a billing year, the starting standard is 500 RMB and the reimbursement rate is 50% for tertiary hospitals, 300 RMB and the reimbursement rate is 60% for secondary hospitals, and there is no starting standard for tertiary hospitals, and the reimbursement rate is 65%.
3. Other urban residents. Within a settlement year, for medical expenses under 100,000 RMB that are eligible for reimbursement, the starting standard for third-level hospitals is 500 RMB, and the reimbursement rate is 50%; the starting standard for hospitalization in second-level hospitals is 300 RMB, and the reimbursement rate is 55%; and first-level hospitals do not have a starting standard, and the reimbursement rate is 60%.
Urban residents who are hospitalized for more than two times in one billing year will no longer be charged the starting standard fee from the second hospitalization. If they are transferred to another hospital or hospitalized for more than two times, the difference will be made up in accordance with the stipulated starting standard for transferring to or re-admitting to the hospital.
Third, the scope of medical insurance can not be reimbursed
The following items are not covered by the medical insurance reimbursement:
1, the category of services.
(1) registration fee, out-of-hospital consultation fee, medical record cost, etc.
(2) visit fee, expedited fee for examination and treatment, surcharge for named surgery, quality and premium fee, self-invited special nurses and other special medical services.
2. Non-disease treatment program category.
(1) a variety of beauty, fitness and non-functional cosmetic, orthopedic surgery, etc.
(2) a variety of weight loss, fat, height projects;
(3) a variety of health checkups;
(4) a variety of preventive, health care treatment programs;
(5) a variety of medical consultation, medical appraisal.
3, diagnostic and treatment equipment and medical materials.
(1) the application of positron emission tomography (PET), electron beam cT, ophthalmic excimer laser therapeutic instrument and other large-scale medical equipment for the examination and treatment program;
(2) glasses, dentures, eye prostheses, prosthetic, prosthetic limbs, hearing aids and other rehabilitative appliances;
(3) all kinds of health care for their own use, massage, checking and treatment equipment;
(4) the provincial price departments stipulate that the disposable medical use cannot be charged separately.
4, treatment program category.
(1) all kinds of organ or tissue transplantation of organ source or tissue source;
(2) in addition to kidney, heart valves, cornea skin, blood vessels, bone, bone marrow transplantation, other organs or tissue transplantation;
(3) myopic orthopedic surgery;
(4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other auxiliary treatment programs.
5. Others.
(1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program;
(2) a variety of scientific research, clinical verification of the diagnosis and treatment program.
According to the law, the medical insurance treatment for cross-provincial medical treatment is carried out in accordance with the directory of the place of medical treatment, which mainly includes the basic medical insurance drug directory, diagnostic and therapeutic items, and medical service facility standards.
Objective of the law:Article 28 of the Social Insurance Law
Medical expenses that are in line with the basic medical insurance drug catalogs, diagnostic and therapeutic items, medical service facility standards, as well as those for emergency and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.