1. Only reimbursement of treatment costs such as dental treatment fees and surgical fees.
2. If admitted by the hospital due to medical condition and meeting the criteria for hospitalization, other than the denture cost which cannot be paid by the medical insurance pool fund, other costs can be settled according to the medical insurance regulations.
3, extractions, fillings and other dental treatment procedures are covered by the medical insurance, dental outpatient clinics in hospitals, the medical insurance reimbursement rate is more than 1800 yuan 50%.
Dental veneers and medical cosmetic procedures are not covered.
Whether you can be reimbursed for a dental visit depends largely on what is being looked at. This is because not all items in dentistry are covered by basic health insurance. Usually dental treatment items will be covered by Medicare, while cosmetic dentistry items are not covered by Medicare.
In the medical insurance reimbursement scope of the main fillings (including basic materials, treatment costs), tooth extraction, and the treatment of periodontal disease, gingivitis and other dental diseases; and not in the medical insurance reimbursement scope of the dental orthodontics, veneers, scaling, porcelain teeth, dental implants and so on.
The new provisions of the health insurance:
One, 2023 onwards, the employee outpatient treatment does not set a ceiling line
At present, the city's employee health insurance participants in a year in line with the city's basic medical insurance payment of statutory outpatient (emergency) clinic fees, the maximum payment limit of 20,000 yuan, more than 20,000 yuan part of the individual's burden.
Since January 1, 2023, there is no longer a maximum payment limit for employee health insurance outpatient clinics, the reimbursement rate will remain unchanged for less than 20,000 yuan; more than 20,000 yuan will be reimbursed by 60% of the active employees, and 80% of the retirees (including the retiree unified supplemental medical insurance), with no cap.
It is expected to benefit 170,000 participants each year, reducing the burden on participants by about 1 billion yuan.
Second, September 1, individual accounts can not be freely withdrawn, to achieve targeted use
In accordance with the requirements of the basic medical insurance fund management, individual account funds should be earmarked for specific purposes.
September 1, 2022 onwards, the individual account funds to implement the bookkeeping management, participants can not be freely withdrawn, to achieve the targeted use, mainly for the payment of insured employees in the designated medical institutions or designated retail pharmacies incurred medical expenses.
Prior to September 1 has been transferred to the health insurance passbook in the individual account funds, participants can still withdraw cash at any time in the future use.
Third, improve the individual account crediting method, the unit to pay part of all into the integrated fund
Since September 1, 2022, the basic medical insurance premiums paid by the employer all into the integrated fund, the basic medical insurance premiums paid by active employees all into the individual account, the proportion of the contribution will remain unchanged; retiree individual account from the integrated fund by the amount of the amount of the transfer, is still the implementation of the The current standard, 70 years of age (excluding) under 100 yuan / month transferred, 70 years of age or older in accordance with 110 yuan / month transferred.
Four, from December 1, personal account can be family ****Jizhi
Since December 1, 2022, allowed to participate in the city's basic medical insurance spouse, parents, children ****Jizhi use of family members of the personal account funds, to pay for their own and ****Jizhi objects incurred in line with the scope of the use of the personal account regulations of the relevant costs, and can use the personal account for their own and * **Jizhi objects to participate in the city's urban and rural residents and residents and ****Jizhi objects, to use the personal account for their own and ****Jizhi objects.
V. Improvement of the level of major illness insurance, the starting line for major illnesses of employees was reduced to 30,404 yuan in the year 2022
In order to further reduce the burden of medical expenses of employees with major illnesses, the starting line for major illness insurance for employees was reduced from 39,525 yuan to 30,404 yuan from the year 2022.
After enjoying the benefits of urban workers' basic medical insurance, participants will be reimbursed twice by the urban workers' major disease medical insurance for the part of their accumulated individual out-of-pocket medical expenses for outpatient and inpatient care in a year that exceeds the starting payment standard.
The reimbursement for the portion above the starting standard of less than 50,000 yuan (i.e., 30,404 yuan to 80,404 yuan) will be 60%, and the portion above 50,000 yuan (i.e., 80,404 yuan) will be 70%, with no ceiling.
It is expected to benefit 35,000 participants annually and reduce the burden on participants by 120 million yuan.
Legal basis:
The People's Republic of China*** and the State Social Insurance Law
Article 26
The treatment standard of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the state regulations.
Article 27
Individuals who have participated in the basic medical insurance for employees and whose accumulated contributions have reached the number of years stipulated by the State when they reach the legal retirement age shall no longer pay the basic medical insurance premiums after their retirement, and shall be entitled to the basic medical insurance benefits in accordance with the State's provisions; if they have not yet reached the number of years stipulated by the State, they may make contributions up to the State's stipulated number of years.
Article 28
Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and salvages, shall be paid out of 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.
Legal basis:
The Chinese People's **** and the State Social Insurance Law
Article 26
Employee basic medical insurance, the new rural cooperative medical care and the basic medical insurance for urban residents of the treatment standard in accordance with the provisions of the State.
Article 27
Individuals who have participated in the basic medical insurance for employees and whose accumulated contributions have reached the number of years stipulated by the State when they reach the legal retirement age shall no longer pay the basic medical insurance premiums after their retirement, and shall be entitled to the basic medical insurance benefits in accordance with the State's provisions; if they have not yet reached the number of years stipulated by the State, they may make contributions up to the State's stipulated number of years.
Article 28
Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and salvages, shall be paid out of 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.