Medicare refers to social medical insurance. It is a social insurance system for the basic medical needs of workers when they are sick according to the laws and regulations of the state and society. The individual account of the medical insurance is a special account set up according to the basic medical insurance policy and used exclusively for storing the medical insurance premiums paid by the insured person and the funds transferred in a certain proportion from the employer's contribution, and recording the medical consumption. The funds in the individual account are used to pay for the out-of-pocket portion of the costs of medical treatment and drug purchases.
Medicare reimbursement is categorized and includes the following items:
1. General medical insurance. It mainly includes outpatient costs, medicine costs, examination costs, etc.
2. Hospitalization insurance. It mainly covers daily hospitalization fee, cost of utilizing hospital equipment, operation cost, medicine cost, etc.
3. Surgical insurance. Provides for all expenses incurred because the patient needs to undergo necessary surgery;
4. Comprehensive medical insurance. Its cost range includes all the costs of medical treatment and hospitalization and surgery, etc.
5, special disease insurance. Certain special diseases often bring the patient a catastrophic payment of expenses that the average resident family can hardly afford. Examples include cancer and heart disease.
Medicare is not reimbursed include, work-related injuries should be paid from the Workers' Compensation Insurance Fund of medical expenses, the health insurance fund does not pay; should be borne by a third person should be borne by a third person's medical expenses, the health insurance fund does not pay, traffic accidents involving a third person; should be borne by the public *** health should be borne by the public *** health medical expenses, the health insurance fund does not pay, prevention of infectious diseases Work.
Legal basis: Article 30 of the Social Insurance Law of the People's Republic of China
The following medical expenses are not included in the scope of payment by the basic medical insurance fund:
(1) those that should be paid from the Workers' Compensation Insurance Fund;
(2) those that should be borne by a third person;
( (iii) Should be borne by the public ****health;
(iv) Medical treatment outside the country.
Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.