1, the main use of health insurance is to pay for outpatient visits.
2. There are other uses for the card, which can be used to buy medicines (over-the-counter drugs), medical equipment, thermometers and blood pressure monitors at designated pharmacies, and other auxiliary testing equipment.
Individual accounts can pay for the following expenses:
1. the cost of medicines purchased at designated retail pharmacies, and the cost of outpatient and emergency medical care;
2. for the purchase of commercial and accidental insurance;
3. medical expenses below the starting standard of the Basic Medical Insurance Coordination Fund;
4. medical expenses exceeding the starting standard of the Basic Medical Insurance Coordination Fund. In case of exceeding the starting payment standard of the Basic Medical Insurance Coordination Fund, the individual will be responsible for a proportionate share of the expenses payable by him/her;
5. The part of the expenses that is not covered by the individual account will be paid by himself/herself.
The co-ordinated account mainly pays for the following expenses:
1. medical expenses for hospitalization;
2. outpatient medical expenses for radiation treatment of malignant tumors, renal dialysis, and anti-rejection drugs after renal transplantation;
3. medical expenses for the patients who are admitted to hospital for treatment after emergency rescue within the first seven days of their hospital stay.
Medicare Reimbursement Scope
1, Medicare card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to illness and some accidents.
The reimbursement formula is: (total cost - threshold fee - out-of-pocket expenses - overspending) * (75 + age * 0.2)%, under normal circumstances, the actual reimbursement rate ranges from 20 to 60%.
Out-of-pocket expenses are not reimbursed, 80% of reimbursement is for Class B drugs, there is a limit on bed charges, and some examination and treatment fees are not reimbursed according to regulations.
2. The reimbursement amount of the health insurance card is 4 times of the average salary of the local social workers (the cumulative value in 1 year).
3. The money in the health insurance card can be used to buy medicines at designated pharmacies and to pay for outpatient and emergency treatment, but it is not reimbursed because the money in the card is the money in the individual account of the health insurance.
4.Reimbursement for Major Disease Insurance
Participants suffering from major illnesses, the individual portion of the out-of-pocket expenses incurred in the city's designated medical institutions, which are in line with the city's health insurance regulations, are included in the scope of the residents of the major disease insurance, and are reimbursed by the funds of the Major Disease Insurance for 50 percent of the expenses. That is, the amount of reimbursement = out-of-pocket expenses × 50%