As for this question, I happen to know how to use medical insurance and whether it is reimbursed by medical insurance. I just sorted out the insurance information about medical insurance. I hope it will be helpful to you:
01How to use medical insurance?
The purpose of buying medical insurance is to be reimbursed when we are sick, but if we buy insurance casually but don’t know how to use it, it will not help?
We know that medical insurance usually refers to basic medical insurance and commercial medical insurance. Let’s talk about how to use them respectively?
1. How to use basic medical insurance:
To use medical insurance, we must first go to a medical insurance designated hospital. At present, almost all public hospitals and some private hospitals fall into this scope. Generally not wrong. ?
(1) Drug catalog?
The drug catalog means that only when the drugs prescribed by the doctor are within the scope of the guaranteed catalog can they be reimbursed. ?
Drugs are generally divided into three categories: A, B, and C; ?
Basic medical insurance can usually reimburse Class A and B drugs, and Class C drugs are self-paid drugs outside the catalog. .
(2) Catalog of diagnosis and treatment items?
Generally, it is the medical services provided to patients by designated hospitals, such as treatment fees, examination fees, surgery fees, etc.;
(3) Catalog of service facilities?
Service facilities mainly refer to bed fees, and there is generally a reimbursement upper limit;
(4)? Deposit line
Basic medical insurance has different deductibles set by different hospitals in different cities, which means that whether it is injections or medicines, the set deductible amount must be reached before it can be reimbursed;
2.? How to use commercial medical insurance:
We know that in some major diseases, imported drugs, special drugs and relatively advanced medical equipment are needed. These costs are generally expensive and cannot be reimbursed by medical insurance. ?
So it can be clearly seen from the picture that apart from the content reimbursed by medical insurance, other self-paid content and self-payment parts, the part below the minimum payment line and above the cap line are what we buy commercial medical insurance Purpose?
As long as we meet the claims conditions, submit an application to the insurance company, prepare the required materials, and get the corresponding reimbursement after review by the insurance company
How to match 02 Social security reimbursement?
Let me give you an example to help everyone understand:?
Lao Wang unfortunately fell and was injured while traveling. He spent 100,000 yuan in the hospital for one day. Lao Wang not only had medical insurance , and there are two commercial medical insurances A and B?
A-The insured amount is 10,000, 0 deductible, and the compensation ratio is 80
B-Assuming that it is an exclusive e-health insurance, the insurance The amount is 1 million, the deductible is 10,000, and the compensation ratio is 100?
The social security insurance is 40,000 yuan, and there is still 60,000 yuan left?
Report A first: 60,000 * 80 = 48,000 yuan , exceeding the maximum insured amount of 10,000, therefore, I can only apply for 10,000, leaving 38,000?
Report B: The 10,000 reimbursed by A can be used to offset the 10,000 deductible for the exclusive e-child Um?
So, the remaining 38,000 can be fully reimbursed. In this way, Xiao Ming did not spend a penny himself
03 I conclude
Basic medical insurance is our The most basic guarantee must be paid on time?
As long as we meet the reimbursement conditions, we can make the most perfect reimbursement plan by combining basic medical insurance and commercial medical insurance.
If you want to learn more about medical insurance, you can check out my previous article: What are some good medical insurance recommendations? A review of the top 20 best-selling high-quality medical insurances in 2020