Medical insurance is an insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. Although medical insurance can provide partial reimbursement when seeing a doctor, the reimbursement scope of medical insurance will be limited by the deductible line, the capping line, the reimbursement ratio and the "two fixed and three catalogues".
1, medical insurance deductible line
The medical insurance deductible line refers to the starting point for the state to reimburse medical expenses. Within one year, if our medical expenses do not exceed the deductible, then these medical expenses need to be paid in our personal medical insurance account or by individuals themselves. Only when the accumulated amount exceeds the deductible line will the excess be reimbursed by the social pooling fund in proportion. Due to the different economic conditions in different regions, the medical insurance deductible lines in different regions are also different.
2. Medical insurance capping line
The medical insurance capping line refers to the maximum reimbursement amount of medical expenses stipulated by the state, and refers to the maximum amount that can be reimbursed for medical treatment in a natural year. The economic situation in different regions is different, so the medical insurance capping line in different regions is different. In principle, the number of medical insurance capping lines is controlled at about 6 times of the average annual salary of local employees.
3. The proportion of medical insurance reimbursement
When medical insurance reimburses our medical expenses, it adopts the * * * payment system. That is to say, when we reimburse medical insurance, the social pooling fund reimburses a part (generally 70%~90%), and the rest is borne by individuals. The level of medical insurance reimbursement is determined by the level of hospitals and the amount of medical expenses we spend. The higher the hospital level, the lower the reimbursement ratio and the higher the personal burden ratio.
4, two fixed-point medical insurance, three directory
The two designated medical insurance are designated hospitals and pharmacies, and the three medical insurance catalogues refer to the basic medical insurance drug list, basic medical insurance diagnosis and treatment items and basic medical service facilities standards.
Medical insurance reimbursement amount = (total cost of treatment-deductible-expenses beyond the scope of reimbursement) × reimbursement ratio;
Self-funded amount of medical insurance = total cost of treatment-reimbursable amount-personal account balance.
2. What is the proportion of medical insurance reimbursement in 2.ICU?
Intensive care unit (ICU), also known as comprehensive treatment room in ICU, can provide treatment, nursing and rehabilitation at the same time, provide isolated places and equipment for patients with serious illness or coma, and provide services such as best care, comprehensive treatment, combination of medical care and nursing, early postoperative rehabilitation, joint care and exercise therapy.
The cost of intensive care unit can be reimbursed through medical insurance, but generally only about 40% is reported. Moreover, the drugs commonly used in ICU are expensive new drugs or imported drugs. This medical insurance is not reimbursed, so it is rarely reimbursed. If the patient gets better, he can be transferred to the general ward.
Generally, the patients admitted to the intensive care unit are patients who have undergone major surgery, need cardiopulmonary resuscitation, have severe trauma and have organ damage. These patients are already very ill. The intensive care unit has special instruments to monitor the patient's breathing, and the nursing staff in the intensive care unit are also very professional doctors and nurses. Medical insurance can reimburse some medical expenses when you are sick, but not in all cases.