A. What are the medical expenses that can be reimbursed
Medical insurance is a kind of insurance that compensates for the medical expenses caused by illness. It is a social insurance that provides necessary medical services or material help by the society or the enterprise when the employee is sick, injured or gives birth. Medical expenses are the costs incurred by the patient for treatment, which include not only the doctor's medical and surgical fees, but also the costs of hospitalization, nursing care, hospital equipment and so on.
Two, medical insurance does not pay the cost of the main categories include the following:
1, the category of services.
(1) Registration fee, medical record cost.
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What are the ways to pay for medical expenses? Here the payment of medical expenses, mainly refers to the people who have purchased health insurance, to the hospital to see the doctor can take the specific ways to pay the corresponding medical expenses.
(A) Starting line method or deduction method
The starting line method refers to the fact that after incurring medical expenses, the insured person first pays a certain amount of medical expenses out of his own pocket, and only medical expenses exceeding this amount will be paid by the medical insurance agency, which is called the "starting line". The starting line method can be divided into three types:
1. Annual cost starting line method: the annual accumulation of medical costs, the accumulated medical costs in a year within a certain amount by the participant to pay, the annual accumulated costs exceeding this amount by the health insurance agency to pay.
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Many people may be injured at work, and most workers are insured against work-related injuries, and can be reimbursed for the medical expenses they incur after an injury.
1, the company's business management department in the company received the news of the injury of employees, to check whether the employee in the company's social security insurance, in the confirmation of the participation in the insurance in the injured person within 24 hours after the injury to the injured person in a timely manner will be the name of the artificial injured, medical insurance number, time of injury, injury parts and the name of the hospital for consultation and treatment of the report to the XX City Medical Insurance Center, the injury section of the registration of the archives. If more than 24 hours to report, the medical insurance center will no longer be accepted;
2, the injured person treatment is completed, the department to fill out the "Employee Workplace Accident Report", "Work Injury Determination Application Form", carrying the injured person injured in the original medical records and discharge summary (copy), the injured person's ID card and the medical insurance card (copy) and other relevant information, submitted to XX Municipal Bureau of Human Resources and Social Security Request for work injury recognition;
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The medical expenses mentioned here are generally a kind of insurance compensation for traffic accidents. When the victim is injured and hospitalized due to a traffic accident, the insurer should compensate the victim accordingly, so what is the limit of compensation for medical expenses?
Medical expenses compensation limit refers to the insured motor vehicle traffic accidents, the insurer for each insurance accident, all the victims of the medical costs of the maximum amount of compensation. Medical expenses include medical fees, consultation fees, hospitalization fees, hospital meal allowance, necessary and reasonable follow-up treatment, cosmetic surgery, and nutritional expenses.
The maximum amount depends on the agreement in the insurance contract, and the law is rarely involved. Usually the full amount will be paid, that is to say, all the expenses you have to pay because you infringe on others. But usually not more than what is agreed in the insurance contract. Inside the insurance relationship involved I will not say, then you think about the policyholder to give the more premiums, then the insurance company will pay more.
Sometimes we will encounter some accidents in the workplace caused by their own injuries, or suffered some occupational injuries, we will be this type of workers in the performance of occupational activities or activities related to occupational activities suffered by the adverse factors of injury and occupational disease injury is called a work-related injury. Then we encountered work-related injuries caused by the misfortune, medical treatment of work-related injuries arising from the medical costs should be borne by who?
Based on the provisions of the Social Insurance Law and the Regulations on Work-Related Injury Insurance, the costs incurred by employees injured at work are partly paid by the Work-Related Injury Insurance Fund and partly paid by the employer. Below I will be categorized from the main body to bear, these costs are summarized for your reference in practice:
I. Costs paid from the Work Injury Insurance Fund:
(a) medical costs of treatment of work-related injuries and rehabilitation costs
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Car accidents routinely cause injuries, and in severe cases at this time can lead to the death of others. When someone is injured, it means that they need to be hospitalized, which means that they will incur medical bills, hospitalization costs, and so on. So do you know how to calculate the medical costs of a car accident?
The formula for calculating the amount of compensation for medical expenses is: medical expenses = medical fees + medical expenses + hospitalization fees + other
It is important to note that the traffic accident victim's medical expenses, the responsible person can be paid in advance before the conclusion of the case as well as at the time of conclusion of the case, but also in the case of the victim in need of medical treatment to pay the victim. The person responsible for the traffic accident refused to pay the victim's medical expenses in advance, the victim or his or her representative can apply to the people's court under the provisions of Article 97 of the Civil Procedure Law, the people's court of first execution, forced to pay the victim's medical expenses in advance.