Generally, Class A drugs can enjoy full coverage, while Class C drugs need all out-of-pocket expenses, and Class B drugs report 80% and pay 20%.
A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you can deduct 2000 yuan first, which is the difference of deductible.
1. Special medical expenses include organ and tissue transplantation due to illness, organ and tissue purchase and use of anti-rejection drugs and immunomodulatory drugs beyond the scope of medical insurance reimbursement for Zhenjiang employees;
1. The medical expenses incurred by the insured employees on business trips or visiting relatives in other places will only be reimbursed for emergency expenses in other places that meet the requirements of medical insurance, and all expenses incurred for hospitalization for non-emergency reasons will not be reimbursed.
2, the insured workers living in the field for more than 6 months, according to the nature of long-term living in the field of medical expenses.
3, long-term residents should provide proof by the unit, determine the secondary designated hospitals (should be designated medical institutions for local medical insurance), and timely handle the "Zhenjiang long-term residents medical expenses reimbursement card".
4. Employees who live in other places for a long time must adhere to the principle of economy and prescribe drugs in a limited amount according to regulations (the acute dosage is within 3 days, the chronic dosage is within 10 days, and the dosage of tuberculosis, hypertension and diabetes can be extended to 30 days). Those who exceed the above standards will not be reimbursed for medicine.
5, long-term resident workers referral, signed by the local designated hospitals, according to the principle of territoriality referral step by step. Referral hospital is a special hospital determined by medical insurance for employees in our city. The individual pays 65438+ 00% of the total expenses first, and then reimburses the expenses according to the medical insurance regulations; In other hospitals, individuals pay 20% of the total expenses first, and then reimburse medical expenses according to medical insurance regulations.
Fold and edit this rural medical insurance reimbursement
1, outpatient compensation:
(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.
(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.
(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.
(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.
(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.
(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.
2, hospitalization compensation
(1) Reimbursement scope:
A. Drug expenses: auxiliary examination: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT and nuclear magnetic resonance are limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).
B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
(2) Reimbursement ratio:
60% reimbursement for town hospitals; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
3. Compensation for serious illness
(1) town risk fund compensation: where the medical expenses of inpatients participating in rural cooperative medical insurance exceed 5,000 yuan at one time or throughout the year, they should be compensated by stages, that is, 5001-kloc-0/0000 yuan will be compensated by 65%,10001-.
(2) The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system inpatient and uremia clinic is1.65,438+0.000 yuan.
The following are not included in the scope of reimbursement of rural cooperative medical insurance:
1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care and medical expenses that do not meet the requirements of family planning;
2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses;
3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;
4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;
5, within the scope of reimbursement, beyond the limit.
Many farmers have purchased some commercial medical insurance after purchasing the "new rural cooperative medical system". If you buy commercial medical insurance, you should first reimburse the expenses of the "New Rural Cooperative Medical System" and then find an insurance company to reimburse the remaining expenses.
Fold and edit this section of urban medical insurance reimbursement
Medical Insurance Reimbursement The scope of urban medical insurance reimbursement refers to all employers in cities and towns, as shown in the following figure:
1. Including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.). );
2 organs, institutions, social organizations, private non-enterprise units and their employees shall participate in the basic medical insurance;
3. Some towns and villages stipulate that township enterprises and their employees, owners of urban individual economic organizations and their employees should be gradually incorporated into the basic medical insurance coverage (the last one depends on different local policies), so that they can enjoy medical reimbursement.
Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. And medical expenses can be reimbursed by medical insurance card in accordance with relevant regulations. Urban medical insurance is relatively specific, with large project scale and coverage, but limited compensation for major diseases or accidents. At this point, the author suggests that the insured can purchase commercial supplementary medical insurance and social security to reduce their economic losses.
Fold and edit employee medical insurance reimbursement in this section.
Medical insurance reimbursement
First, the basic insurance does not pay the cost of the scope of medical treatment projects.
(1) service items
1, registration fee, out-of-hospital consultation fee, medical record fee, etc.
2. Special medical services such as visiting fees, urgent fees for examination and treatment (except for emergency), surcharge for name calling operation, high quality and good price, and special care by oneself.
(2) Non-disease treatment projects
1, various beauty (life beauty, medical beauty) bodybuilding projects and disorderly non-functional plastic surgery, orthopedic surgery, etc. ;
2. Various weight loss, weight gain and height increase projects;
3. Various health checks;
4, all kinds of prevention and health care projects;
(3) Diagnostic equipment and medical materials.
1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;
2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
(4) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;
Two, the basic medical insurance to pay part of the cost of diagnosis and treatment project scope
(a) diagnosis and treatment equipment and medical materials
1, using X-ray computed tomography (CT), stereotactic radiotherapy device (γ knife, χ knife), cardiac and angiographic X-ray machine (including digital subtraction device), magnetic resonance imaging device (MEI), single photon emission computerized scanning device (SPECT), color Doppler instrument, medical linear accelerator and other large medical equipment.
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3. Pacemakers, artificial joints, intraocular lenses, vascular stents, etc. replace artificial organs in vivo and place materials in vivo;
4, the provisions of the provincial price department can be charged separately for disposable medical materials.
(2) Treatment items
1, hemodialysis, peritoneal dialysis;
2. Transplantation of kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow;
3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects.
Hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
(3) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(4) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;
4, all kinds of prevention and health care projects;
(3) Diagnostic equipment and medical materials.
1, a project for examination and treatment with large medical equipment such as positron emission tomography, electron beam CT and ophthalmic excimer laser therapeutic apparatus;
2, glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
(4) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;
Two, the basic medical insurance to pay part of the cost of diagnosis and treatment project scope
(a) diagnosis and treatment equipment and medical materials
1, using X-ray computed tomography (CT), stereotactic radiotherapy device (γ knife, χ knife), cardiac and angiographic X-ray machine (including digital subtraction device), magnetic resonance imaging device (MEI), single photon emission computerized scanning device (SPECT), color Doppler instrument, medical linear accelerator and other large medical equipment.
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy;
3. Pacemakers, artificial joints, intraocular lenses, vascular stents, etc. replace artificial organs in vivo and place materials in vivo;
4, the provisions of the provincial price department can be charged separately for disposable medical materials.
(2) Treatment items
1, hemodialysis, peritoneal dialysis;
2. Transplantation of kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow;
3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects.
Hearing AIDS and other rehabilitation equipment;
3, all kinds of self-use health care, massage, rehabilitation and treatment equipment.
(3) Treatment items
1, the organ source or tissue source of various organ transplants or tissue transplants;
2. Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow;
3. Orthopedic surgery for myopia;
4, Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(4) Others
1, various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects;
2, all kinds of scientific research, clinical verification of diagnosis and treatment projects;