Medical insurance reimbursement items
1. General medical insurance
Including outpatient expenses, medical expenses, examination expenses, etc.
2. Hospitalization insurance
Daily hospitalization expenses, hospital equipment expenses, surgical expenses, medical expenses, etc.
3. Surgery insurance
Provides insurance for patients who need to undergo necessary surgeries. All expenses incurred
4. Comprehensive medical insurance
The cost range includes all expenses such as medical treatment, hospitalization and surgery
1. Medical insurance reimbursement conditions
1. Insured persons must go to the designated medical institutions of the basic medical insurance for medical treatment and purchase drugs, or go to the designated retail pharmacies determined by the social insurance agency to purchase drugs with the medical prescription issued by the doctor in the designated hospital
2. The medical expenses incurred by insured persons during medical treatment must comply with the scope and payment standards of the basic medical insurance drug catalog, diagnosis and treatment items, and medical service facility standards before they can be paid by the basic medical insurance fund in accordance with regulations
3. Among the medical expenses of insured persons that are within the payment scope of basic medical insurance, the portion of the expenses above the minimum payment standard of the social medical co-ordination fund and below the maximum payment limit will be paid by the social medical co-ordination fund in a uniform proportion
2. It is not within the scope of medical insurance reimbursement
1. Medical expenses incurred by insured employees on business trips or visits to relatives in other places will only be reimbursed for out-of-town emergency expenses that comply with medical insurance regulations. All hospitalization expenses for non-emergency reasons will be reimbursed. No expenses will be reimbursed
2. If insured employees live out of town for more than 6 months, medical expenses will be reimbursed according to the nature of long-term out-of-town residents
3. Long-term out-of-town residents shall be reimbursed. The unit provides certificates, identifies two designated hospitals (which should be designated medical institutions for local medical insurance), and promptly applies for the "Medical Expense Reimbursement Card for Zhenjiang Long-term Employees Living in Non-local Areas"
4. Employees who live in non-local areas for a long time must persist in economy In principle, medicines should be prescribed in limited quantities according to regulations (for each visit, the dose for acute diseases should be within 3 days, the dose for chronic diseases should be within 10 days, and the dose for tuberculosis, hypertension, and diabetes can be extended to 30 days). If the above standards are exceeded, the drug fee will not be paid. Reimbursement
5. Referrals for employees who live out of town for a long time must be signed by the local designated hospital, and the referrals must be made step by step according to the territorial principle. The referral hospital is a special hospital designated by our city’s employee medical insurance. Individuals will pay 10% of the total expenses first, and then be reimbursed according to medical insurance regulations. For other hospitals, individuals will pay 20% of the total expenses first, and then be reimbursed according to medical insurance regulations. Cost
Legal Basis
"Social Insurance Law of the People's Republic of China"
Article 23 Employees shall participate in employee basic medical insurance, which shall be paid by the employer Units and employees must pay basic medical insurance premiums together in accordance with national regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexible employment personnel can participate in the basic medical insurance for employees, and individuals must pay for the basic medical insurance in accordance with national regulations. fee.
Article 26: The treatment standards of basic medical insurance for employees, new rural cooperative medical insurance and basic medical insurance for urban residents shall be implemented in accordance with national regulations.