Medical insurance does not necessarily cover hospitalization, but also outpatient visits.
Medical insurance covers a wide range of expenses, and medical expenses are generally differentiated according to the characteristics of the medical service, which mainly include doctor's outpatient expenses, medication, hospitalization, nursing care, miscellaneous hospital expenses, surgical expenses, and various examination costs. Medical expenses are the costs incurred by the patient for the treatment of the disease, which includes not only the doctor's medical and surgical fees, but also the costs of hospitalization, nursing care, hospital equipment and so on.
Ratio and scope of reimbursement of medical insurance:
1. Outpatient and emergency medical expenses: the part of medical expenses exceeding 2,000 yuan in total within the annual period (January 1~December 31) of an active employee that is in line with the scope of basic medical insurance.
2. Settlement ratio: 50% reimbursement for the part of over 2,000 yuan for dispatched staff during the contract period, and 50% out-of-pocket payment by individuals; the maximum amount of outpatient and emergency reimbursement paid to dispatched staff is 20,000 yuan cumulatively in a year.
3. Participants should keep the outpatient medical receipts (including receipts and prescription bottoms for the parts below the large amount) of the outpatient consultation at the designated hospitals as the vouchers for reimbursement of medical expenses.
4, three kinds of special disease outpatient medical treatment: participants suffering from malignant tumors radiation therapy and chemotherapy, kidney dialysis, renal transplantation to take anti-rejection drugs need to be in outpatient medical treatment, by the participant's second and third-class hospitals for medical treatment of the designated hospitals to issue a "diagnosis of the disease certificate" and fill out the "medical insurance special disease declaration and approval form", reported to the regional medical insurance center for approval and filing. The form will be submitted to the district medical insurance center for approval and filing. Outpatient medical treatment and medicine collection for these three special diseases are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical fees incurred are within the scope of outpatient special diseases, they will be settled with reference to hospitalization.
5. For inpatient medical treatment, the medical insurance payment is enough for 20 years in order to enjoy the medical insurance reimbursement after retirement.
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