Now the material cost of urban medical insurance surgery can not be reimbursed. The basic medical insurance for urban residents is a part of the social medical insurance, taking the government as the leading, with the residents' individual (family) contribution as the main, the government moderate subsidy as the supplementary financing method, in accordance with the principle of the standard of contribution and the treatment level of the principle of consistency, to provide the urban residents with medical needs of the medical insurance system. At present, our national regulations now urban medical insurance surgery material costs can not be reimbursed.
II. Medical insurance reimbursement rate how to calculate?
When it comes to how to calculate the percentage of health insurance reimbursement, if you are an active employee, you can only be reimbursed for medical expenses of more than 2,000 yuan after visiting the outpatient or emergency clinic of a hospital, the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, the reimbursement rate is 80 percent for expenses over $1,300.
And regardless of the type of person, the maximum limit for expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and you spend $2,500 on an outpatient visit, you can be reimbursed 50 percent of the $500 portion, which is $250.
In the case of hospitalization expenses, the current starting amount is $1,300 for the first time you use basic medical insurance to pay in a year, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is determined at 50 percent, which is 650 yuan. And the maximum amount of payment for hospitalization expenses is currently 70,000 yuan in one year for the basic medical insurance pool fund.
The standard of hospitalization reimbursement is related to the level of the hospital in which the insured person is staying, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, or 85% reimbursement; from 30,000 yuan to 40,000 yuan, the employee pays 10%, and is reimbursed 90%; more than 40,000 yuan to the maximum payment limit portion of the cost, then 95% are reimbursed, the employee only needs to pay 5%. And retirees pay 60 percent of what active employees pay individually, but anything below the starting standard is paid by the individual.
Basic medical insurance for urban residents is an integral part of social medical insurance, which takes the government as the leading role, with the residents' individual (family) contributions as the mainstay and the government's moderate subsidies as the supplementary financing method, and provides medical insurance system for the medical needs of urban residents in accordance with the principle of the consistency of the standard of contribution and the level of treatment. At present, our national regulations now urban medical insurance surgery material costs can not be reimbursed.
Medical insurance does not pay for the project
(a) service category.
(1) registration fee, out-of-hospital consultation fee, medical record cost;
(2) consultation fee, examination and treatment expediting fee, naming surgery surcharge, high quality and premium fee, self-employed special nurse and other special medical services.
(2) The category of non-disease treatment programs.
(1) a variety of beauty, fitness and non-functional cosmetic, orthopedic surgery;
(2) a variety of weight loss, weight gain, height projects;
(3) a variety of physical examination;
(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 device (PET), electron beam cT, ophthalmic excimer laser therapeutic instrument and other large-scale medical equipment for the examination and treatment program;
(2) glasses, denture, eye prosthesis, prosthetic, prosthetics, hearing aids and other rehabilitative appliances;
(3) all kinds of self-use of health care, massage, checking and treatment equipment;
(4) the provincial price department regulations can not be charged separately for disposable medical use.
(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 of other organs or tissue transplantation;
(3) myopic orthopedic surgery;
(4) qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects.
Legal basis:
Article 29 of the Social Insurance Law of the People's Republic of China (PRC) states that the portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly by the social insurance administration organization with the medical institutions and the drug business units. The administrative departments of social insurance and health administration shall establish a settlement system for medical expenses for medical treatment in other places to facilitate the enjoyment of basic medical insurance by insured persons.