1. How to reimburse expenses during the upgrade of the medical insurance system
Medical insurance refers to social medical insurance. It is a social insurance system for the state and society to provide workers with basic medical needs when they fall ill in accordance with laws and regulations. Due to the upgrade of the medical insurance system, medical expenses cannot be settled. Medical insurance should be reimbursable for medical expenses incurred in this situation. You should directly contact the medical insurance agency in the insured place.
Legal basis: "Social Insurance Law of the People's Republic of China" Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit. .
The social insurance administrative department and the health administrative department should establish a medical expense settlement system for medical treatment in other places to facilitate insured persons to enjoy basic medical insurance benefits.
2. Medical insurance reimbursement ratio
First, the amount that can be reimbursed by medical insurance is: reimbursement amount = (total medical expenses - self-pay - self-pay - threshold) Second, if the party concerned incurs medical expenses that exceed the maximum payment limit of the basic medical co-ordination fund, the social insurance department will reimburse 85% of the amount for less than 0-40,000 yuan, 90% for less than 40,000-80,000 yuan, and 90% for less than 80,000 yuan. 95% reimbursement for fees above RMB 10,000.
Legal basis: "Social Insurance Law of the People's Republic of China" Article 30 The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(1) It should be paid from the work-related injury insurance fund;
(2) Should be borne by a third party;
(3) Should be borne by the public health department;
(4) Seeking medical treatment abroad.
Medical expenses shall be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first. After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.