Beijing dental cleaning medical insurance reimbursement

Beijing will be scaling into the medical insurance reimbursement scope, scaling can be reimbursed medical insurance. It is understood that tooth filling, tooth extraction, scaling, periodontal treatment and other common items are now in the medical insurance coverage. However, the filling adhesive used in the process of filling treatment belongs to the out-of-pocket expenses, the doctor will be informed in advance. It should be noted that if people need to polish their teeth after scaling, it is a self-funded item. Participants can take their medical insurance card to the designated medical institutions in the insured area to register and go to the dental department to see a dentist.

Meaning of medical insurance

Medicare refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide protection for the basic medical needs of the workers covered by the insurance in case of illness. The basic medical insurance fund consists of a general fund and individual accounts. The basic medical insurance premiums paid by individual workers are all credited to individual accounts; the basic medical insurance premiums paid by employers are divided into two parts, one of which is credited to individual accounts and the other is used to set up a comprehensive fund.

Dental insurance coverage

Most of the regional dental insurance coverage are:

1, fillings (including basic materials, treatment costs);

2, tooth extraction;

3, treatment of periodontal disease, gingivitis and other dental diseases incurred costs.

And the items that cannot be reimbursed by health insurance are:

1, dental veneers

2, porcelain teeth

3, dental scaling

4, orthodontic treatment

5, dental implants

China's basic medical insurance system is based on the model of combining a social coordinating system with individual accounts. In principle, basic medical insurance funds are coordinated at the local and municipal levels. Basic medical insurance covers all employers and their employees in cities and towns; all enterprises, state administrative organs, public institutions and other units and their employees must fulfill the obligation to pay basic medical insurance premiums. At present, the contribution rate for employers is about 6% of total wages, and the contribution rate for individuals is 2% of their own wages. The basic medical insurance premiums paid by an organization are partly used to establish a centralized fund and partly transferred to an individual account; the basic medical insurance premiums paid by an individual are credited to an individual account. The integrated fund and individual account bear different responsibilities for the payment of medical expenses. The integrated fund is mainly used to pay for hospitalization and part of the outpatient treatment of chronic diseases, the integrated fund has a starting standard, the maximum payment limit; individual account is mainly used to pay for general outpatient costs. According to the above content we can know, if you are in the hospital teeth cleaning medical insurance is not reimbursed, dental insurance into the scope of the main: fillings (including basic materials, treatment costs), extraction, treatment of periodontal disease, gingivitis and other dental costs.

Medicare reimbursement first need to submit a reimbursement form and other related materials to the social security institutions for processing, and then the relevant departments after receiving the materials will be audited. After the review, the payment will be made. After the approval of the relevant departments of the social security will be reimbursed, the health insurance is mainly to reimburse the reimbursement of the reimbursement of hospital-related expenses.

General health insurance reimbursement is how to reimbursement

1, the applicant to submit reimbursement documents and other materials to the social security institutions acceptance;

2, acceptance of the department since the receipt of the application materials, audit, settlement, payment of the work;

3, social security institutions approved the application, the applicant to receive social health insurance medical expense reimbursement bill to be reimbursed.

Legal basis:

The People's Republic of China *** and the State Social Insurance Law, Article 2 The State establishes the basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance and other social insurance system, to ensure that the citizens in old age, disease, industrial injury, unemployment, childbirth and other situations in accordance with the law from the State and society to obtain material assistance. The right to receive material assistance from the State and society in cases of old age, sickness, work-related injury, unemployment and childbirth.

The Social Insurance Law of the People's Republic of China Article 28 Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.