With the improvement of living standards, more and more people are participating in medical insurance and want to benefit from it. However, although medical insurance serves the people, its medical insurance reimbursement also has a certain range. The following is a detailed introduction to the division of medical insurance reimbursement scope. "Youxiangkangjian" critical illness insurance plan covers cancer in situ and 30 types of critical illness protection
1. Reimbursement scope of basic medical insurance for urban employees
The basic insurance for employees does not The scope of payment items includes: registration fee, out-of-hospital consultation fee, case cost, consultation fee, expedited fee, etc. There are also some non-disease treatment items that are not reimbursed. Such as various cosmetic surgeries including weight loss and health care type treatment projects. There are also various medical consultations and medical appraisals that are outside the scope of medical reimbursement. For example, there is a Ms. Zhang who wants to undergo rhinoplasty surgery at a beauty hospital. This treatment operation is voluntary rather than passive, and it is non-disease treatment, so the cost will not be reimbursed.
The scope of non-reimbursement also includes the application of positron emission tomography equipment, electron beam CT, laser therapy equipment and other large medical equipment, which are not reimbursable. When using glasses, dentures, hearing aids and other rehabilitation equipment, expenses will not be reimbursed. A Mr. Zhang chose an eye hospital and wanted to undergo myopia surgery. Mr. Zhang’s surgery was not covered by reimbursement. There was also Ms. He. She accidentally lost too much blood and died during a facial cosmetic surgery. Her family went to the medical insurance agency to ask for compensation and reimbursement. However, the agency refused to reimburse or compensate because Ms. He performed the surgery. Surgery is a cosmetic surgery, which is a non-disease treatment item. The insurance terms clearly stipulate that the cost of such treatment items and postoperative expenses are not covered by medical insurance reimbursement. Therefore, the compensation requested by Ms. He’s family is not protected by law.
II. Scope of reimbursement of student medical insurance
Protecting students’ personal safety and avoiding accidents is the social responsibility of local people’s governments at all levels and their relevant departments, as well as students’ parents and guardians. Same responsibility. My parents are old, how can I buy insurance? I just compiled relevant content, I hope it will be helpful to you: When buying insurance for your parents and the elderly, you must avoid these pitfalls!
For schools, when handling student injury accidents, they should follow the principles of fairness, justice, reasonableness and timeliness, and be realistic, accurate in characterization, and clear in responsibilities. Generally speaking, if a student suffers an accidental injury at school, as long as the third party is not responsible, the school should reimburse medical expenses based on the extent of the injury. Schools should pay attention to the safety of teaching in dangerous teaching situations, such as chemistry experiment classes. If a student is injured in such a class, the school will also have to reimburse the medical expenses incurred. Schools also need to strengthen safety inspections on a regular basis, and promptly protect or repair facilities and equipment that pose safety risks. In the event of an accident, medical insurance reimbursement is also included. How to buy critical illness insurance cost-effectively? Regarding choosing term or lifetime insurance, I have just compiled relevant content, I hope it will be helpful to you: term critical illness insurance vs lifetime, how to choose?
There is a case about student medical insurance reimbursement. When a primary school student was riding someone else's bicycle, he accidentally fell because the road in the school was uneven. As a result, the student's parents approached the school to ask for compensation, but the school claimed that the injury accident was a third-party liability because the student fell while riding someone else's bicycle, and the responsibility should lie with the cyclist. After several arguments, the school held a meeting to discuss carefully and finally agreed to compensate the student for his medical expenses. Because the main factor that causes bicycles to fall is that the roads on the school campus are uneven and slipping accidents are prone to occur. After the school handled the student's compensation accident, it immediately started repairing the road to prevent such an accident from happening again.
3. Standards and reimbursement ratios for urban residents’ basic medical insurance reimbursement scope
If a student or child has an accident within the reimbursement scope within a accounting year, and For medical expenses below 180,000 yuan, the minimum payment standard for third-level hospitals is 500 yuan, and the reimbursement rate is 55%; while the minimum payment standard for second-level hospitals is 300 yuan, and the reimbursement rate is 60%; There is no minimum payment standard for Grade 1 hospitals, and the reimbursement rate is 65%.
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If you are an elderly person over 70 years old. In one accounting year, if medical expenses not exceeding 100,000 yuan are incurred that meet the scope of reimbursement, the minimum payment standard for level 3 hospitals is also 500 yuan, as for level 3 hospitals, level 2 hospitals and level 1 hospitals, and so on.
For other urban residents, if they incur treatment expenses of less than 100,000 yuan within the reimbursement range in one accounting year, the reimbursement ratio of the third-level hospital is 50%; the reimbursement ratio of the second-level hospital is 100%. Fifty-five percent, the reimbursement ratio for first-level hospitals is 60%.
The treatment expenses incurred by the insured at designated medical institutions or designated medical stores can also be included in the reimbursement scope of the Urban Resident Basic Medical Insurance Fund.
IV. Regarding the scope and proportion of reimbursement of rural cooperative medical insurance
For example, the reimbursement rate for treatment at a village clinic or village health center is 60%, and the reimbursement rate for treatment at a town health center is 60%. 40%, and the cost limit for various prescription drugs is 100 yuan. The reimbursement rate for medical treatment in secondary hospitals is 30%, and the prescription drug cost limit is 200 yuan. The reimbursement rate for medical treatment in tertiary hospitals is 20%. When hospitalized in a town health center, the treatment cost for elderly people over 60 years old will be compensated at 10 yuan per day, with a maximum limit of 200 yuan.
In short, all policyholders should be clear about the scope of insurance compensation expenses to be applied for to avoid unnecessary compensation disputes. "Lekang Wuyou" refundable hospitalization medical insurance plan has the dual functions of insurance protection and premium refund