Excessive price co-payment means the need for out-of-pocket expenses in excess of the reimbursement standard of the medical insurance. According to the relevant provisions of the medical insurance, the full amount of Category A drugs are included in the overall reimbursement. Class B medicines are covered by a certain percentage of out-of-pocket expenses before being included in the overall payment according to the medical insurance catalog. The hospitalized medical insurance fund reimburses 70% of the out-of-pocket expenses of the urban workers' medical insurance, and is claimed twice a year; the outpatient special disease fund reimburses 50% of the out-of-pocket expenses of the urban workers' medical insurance, and is claimed cumulatively once a year.
What are the items included in the medical insurance reimbursement
The classification of the medical insurance reimbursement as well as the items included are as follows:
1, general medical insurance. It mainly includes outpatient costs, medical costs, examination costs and so on.
2. Hospitalization insurance. It mainly covers daily hospitalization fee, cost of utilizing hospital equipment, surgery cost, medicine cost and so on.
3. Surgical insurance. Provides for all expenses incurred due to necessary surgery required by the patient.
4. Comprehensive medical insurance. Its cost coverage includes all costs of medical treatment and hospitalization and surgery, etc.
5, special disease insurance. Certain special diseases often bring the patient a catastrophic cost payment, the average resident family can hardly afford. Examples include cancer and heart disease. Provide coverage for policyholders of major diseases, can be a single, such as malignant tumors, or even malignant tumors in a certain number of cancers.
I hope the above can help you, if you have other questions please consult a professional lawyer.
Legal basis: "The Chinese People's **** and the State Social Insurance Law"
Article 23 of the employees shall participate in the basic medical insurance, by the employer and the employee in accordance with the provisions of the State **** with the payment of basic medical insurance premiums. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.
Article 24: The State shall establish and improve a new type of rural cooperative medical care system. The administration of the new rural cooperative medical care shall be regulated by the State Council.