Medical insurance reimbursement scope and standard:
If the social security of the medical insurance reimbursement scope is for the medical insurance catalog for reimbursement of items, including drugs, diagnostic and therapeutic items and medical service facilities.
1, drugs are categorized into Class A, Class B and Class C drugs, of which Class A drugs are essential for clinical treatment and are widely used, and the cost of these drugs is fully reimbursed according to the proportion of medical insurance. Class B drugs are first paid a certain percentage, and then reimbursed according to the medical insurance, the specific reimbursement rate is different in different places of the medical insurance bureau regulations are different.
2, diagnostic and treatment items refers to the hospital for treatment, the use of medical instruments, equipment and medical materials, mainly two ways to reimbursement of full co-ordination of the project is fully included in the medical insurance reimbursement, according to the prescribed proportion of payment. Part of the integrated project, is to pay a part of the first, and then reimbursement in accordance with the prescribed proportion.
3, the standard of medical service facilities, refers to the hospitalization bed fee, outpatient hospitalization bed fee and so on, the scope of reimbursement and standards vary from place to place.
For example:
1, the outpatient reimbursement rate is 50%, and the hospitalization starting standard is divided into hospitals to see, the third level and above is 700 yuan a year starting standard, the second level of hospitals is 600 yuan a year starting standard, the first level and the following is 500 yuan a year.
2. The reimbursement rate for Category A and general treatment is 85%, and the reimbursement rate for Category B drugs is 75%.
3. In case of chronic diseases, special diseases and serious diseases, the starting standard is 700 yuan for the year, and 80% is paid for Category A and general treatment, 75% for Category B, and 70% for high precision.
If the medical insurance reimbursement scope and standards of commercial insurance, different insurance requirements are different, subject to the terms and conditions, such as million medical insurance reimbursement scope of general medical care and critical illness medical care, including inpatient hospitalization, special outpatient, hospitalization before and after the outpatient emergency and outpatient surgery reimbursement, some of the million medical insurance, and the proton reion medical care, reimbursement of the cost of specific medicines, serious illnesses diagnosis There are also proton reion medical coverage, reimbursement of specific drug expenses, a critical illness diagnosis allowance, and a critical illness hospitalization allowance.
The payment standard is divided into general medical insurance, there is a deductible of 10,000, equivalent to more than 10,000 can be reimbursed, after deducting the social security reimbursement and deductible can be 100% reimbursement, the critical illness is usually no deductible, after deducting the social security reimbursement, direct reimbursement of the proportion of 100%.