Social medical insurance reimbursement scope includes basic medical insurance drug reimbursement, basic medical insurance diagnostic and treatment program reimbursement, and basic medical service facility reimbursement. The way of purchasing medical insurance for major diseases includes clarifying the scope of coverage, the amount of coverage needs to be set reasonably, and the way of payment should be clear. Medical insurance includes general medical insurance, hospitalization insurance and surgical insurance. Among them, the reimbursement scope of social medical insurance includes the following points: 1. Reimbursement of basic medical insurance medicines are included in the basic medical insurance benefit scope of Category A and Category B medicines can be reimbursed. Among them, Class A drugs are those that are basically unified nationwide and can guarantee basic clinical needs. Class B drugs are included in the scope of basic medical insurance benefits after the employees pay a certain percentage of the costs, and the costs are generally paid according to the basic medical insurance benefit standards.2. The scope of the diagnostic and therapeutic items of the basic medical insurance payment program must be determined in accordance with the Scope of the Basic Medical Insurance Diagnostic and Therapeutic Items stipulated by the state. If it belongs to the catalog of diagnostic and therapeutic items for which the basic medical insurance pays part of the expenses, the insured person can pay out of pocket first, and then pay the expenses according to the regulations of the basic medical insurance.3. Reimbursement of basic medical service facilitiesThe reimbursement of the basic medical insurance medical service facilities covers the living service facilities that are necessary for the insured persons in the process of receiving diagnosis, treatment and care, which includes outpatient and emergency inpatient hospitalization beds and inpatient hospitalization beds. The basic medical insurance fund cannot reimburse referral transportation fee, emergency vehicle fee, baby warming box fee, food warming box fee, nursing fee, escort fee. Second, how to buy a major medical insurance to buy a major medical insurance include: 1. clear scope of coverage 2. the amount of coverage set to be reasonable 3. the payment method should be clear three, what does medical insurance include medical insurance include: 1. general medical insurance general medical insurance to the insured to provide treatment of disease related to the general medical costs. It mainly includes outpatient costs, medicine costs, examination costs and so on. This type of insurance has a lower premium cost and is more applicable to the general public.2. Hospitalization insuranceHospitalization costs are treated as a separate insurance policy because the costs incurred for hospitalization are often high. The cost items of hospitalization insurance are mainly the daily hospital fee (bed fee), the cost of utilizing hospital equipment, the cost of surgery, and the cost of medicine, etc. 3. Surgical insurance This type of insurance provides for all costs incurred as a result of a patient needing to undergo a necessary surgery. 4. Comprehensive medical insurance Comprehensive medical insurance is a comprehensive medical expense insurance provided by the insurer for the insured person, which covers medical treatment and all expenses incurred for hospitalization, surgery, etc. All expenses. The premium for this type of policy is higher. Generally a low deductible is determined along with an appropriate sharing ratio.5. Specialty Disease Insurance Certain specialty diseases often bring catastrophic cost payments to the patient, which are difficult for the average resident family to afford. Examples include cancer, heart disease, etc. Therefore, people usually require such policies to have a relatively large sum insured in order to be sufficient to cover the various expenses incurred by them.
Legal Objective:Social medical insurance refers to the fact that when a worker is sick, the social insurance institution will give appropriate subsidies or reimbursement for the medical expenses he or she needs, so that the worker can recover his or her health and labor ability and be put into the process of social reproduction as soon as possible. First, medical insurance 1, medical insurance is divided into two accounts, individual account, embodied in the medical insurance card money, can be used to buy drugs at designated pharmacies, outpatient payment and hospitalization costs in the individual out-of-pocket payment; co-ordinated account, managed by the medical insurance center, the insured person occurs in line with the local medical insurance reimbursement of the cost of the co-ordinated account to pay for 2, in the medical treatment (hospitalization), the hospital to present to the designated hospitals to prove that the medical insurance card When checking out the bill, the part that the individual pays out-of-pocket will be paid by the medical insurance card or cash, and the part that is reimbursed by the medical insurance will be settled by the medical insurance and the hospital, so the individual does not need to pay and then reimbursement. And those medical expenses in the outpatient clinic can not be reimbursed. Second, the social health insurance reimbursement hospital different health insurance reimbursement ratio is different: if a person in the hospital with 10,000 yuan, if it is in the first hospital inpatient, then first subtract 500 yuan; if it is in the second hospital inpatient, then first subtract 1,000 yuan; if it is the third hospital inpatient, then first subtract 2,000 yuan; after that, remove the After that, we will deduct "non-medicare medication costs" and "other non-medicare costs", leaving 80% for active employees and 50% for retired, unemployed and jobless. (Note: health insurance reimbursement only insures Class A drugs that are used for medical insurance, Class B is not reimbursable for non-medicare use.) The ratio of reimbursement for hospitalization of working employees, the total cost of hospitalization, in addition to the out-of-pocket part of the costs, Class B costs first 10% out-of-pocket, more than the part of the hospital health care insurance threshold fee, to enjoy the proportion of the overall payment of the hospital level of the different threshold fees, to enjoy the proportion of the overall payment of the hospital level is also different. The proportion of employee medical insurance is more than 80% (82%/84%/87% in Wuhan), and the proportion of resident medical insurance is about 70% (80%/65%/50% in Wuhan). The social security card does not adjust any medical reimbursement rate, according to the "Beijing Basic Medical Insurance Regulations" issued in 2005, the social supplemental medical insurance for retirees under 70 years of age is 50%, and in the reimbursement procedures at the contributing organization, you need to prepare a copy of the medical insurance handbook, bills, receipts, details, etc., and for details, you can also consult the labor security phone number 12333. It should be noted that on January 29, 2012, business, "Twelfth Five-Year" period of urban and rural economic and social integration development plan was announced. 2015, Beijing will establish urban and rural integration of industrial injury, maternity insurance system. It will explore the inclusion of members of rural cooperative organizations, self-employed entrepreneurs in towns and villages, and flexibly employed people in the system of work injury insurance. The city will also increase the city's urban and rural low income insurance work co-ordination efforts, and gradually increase the level of low income insurance and narrow the gap between urban and rural areas, to effectively protect the basic life of low-income groups.