At the time of reimbursement, many people don't quite understand why some drugs can be reimbursed and some drugs can't, especially wondering why others can reimburse the same medical insurance and drugs that they can't reimburse. It also brings joy or worry to different insured.
First, urban medical insurance reimbursement
Medical Insurance Reimbursement The scope of urban medical insurance reimbursement refers to all employers in cities and towns, as shown in the following figure:
1. Including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.). );
2 organs, institutions, social organizations, private non-enterprise units and their employees shall participate in the basic medical insurance;
3. Some towns and villages stipulate that township enterprises and their employees, owners of urban individual economic organizations and their employees should be gradually incorporated into the basic medical insurance coverage (the last one depends on different local policies), so that they can enjoy medical reimbursement.
Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. And medical expenses can be reimbursed by medical insurance card in accordance with relevant regulations. Urban medical insurance is relatively specific, with large project scale and coverage, but limited compensation for major diseases or accidents. At this point, the author suggests that the insured can purchase commercial supplementary medical insurance and social security to reduce their economic losses.
Second, the employee medical insurance reimbursement process is as follows:
The expenses incurred by the insured during outpatient treatment in the hospital, drug purchase or drug purchase in designated pharmacies can be paid by the personal account IC card issued by the medical insurance center. The part beyond the personal account amount is taken care of by the individual, and the personal account amount is actually included according to the payment progress of the unit. The general situation is that the unit pays the fee in the current month and will be included in the next month.
When the insured employees are hospitalized, the hospitalization medical expenses below the Qifubiaozhun shall be paid by the employees themselves; The hospitalization medical expenses above Qifubiaozhun and below the maximum payment limit shall be paid by the overall fund and individual employees according to the hospital level. First-class hospitals, individuals pay 5%; Secondary hospitals, individuals pay 6%; For tertiary hospitals, individuals pay 7%.