Can residents' medical insurance be reimbursed?

Medical insurance can be reimbursed if the cost of drug purchase is within the scope of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards. The parties can bring their own social security cards and other information and go directly to the pharmacy for settlement.

I. Reimbursement for urban and rural residents:

1. General outpatient reimbursement is 50% of the fee, and 450 yuan will be reimbursed for up to one year, but the contract must be signed in advance.

2. The proportion of reimbursement for medical hospitalization of urban and rural residents is the lowest 38.5% and the highest 90%. Different parameters will have different reimbursement rates, so you should clearly know the contents of hospitalization reimbursement, such as what level of hospital you live in, what is the minimum payment standard, and the ratio of low-grade hospitals to high-grade hospitals is different.

3. The medical expenses incurred in hospitalization (including outpatient chronic diseases) in a serious illness insurance year, if the personal cumulative burden exceeds10.2 million yuan, can be reimbursed by the serious illness insurance, and the reimbursement limit is 400,000 yuan.

4. Outpatient medication for hypertension and diabetes will be reimbursed to 300 yuan and 400 yuan respectively within one year. Those who suffer from hypertension and diabetes at the same time can be reimbursed 525 yuan, but it will not occupy the share of general outpatient service in 450 yuan.

5. Suffering from chronic diseases At present, there are 46 chronic diseases covered by residents' medical insurance. The combined calculation of outpatient chronic diseases and hospitalization medical expenses within one year can be reimbursed up to 1.5 million yuan. However, the insured patients need to be checked and confirmed by the local medical insurance institutions, and then go to the designated medical institutions for outpatient treatment of special chronic diseases.

6. Maternity medical care conforms to the family planning policy, and the medical expenses for hospital delivery are reimbursed to 800 yuan. In non-designated hospitals, only 70% of the quota standard is reimbursed, that is, 560 yuan 7. Long-term residents, migrant workers, entrepreneurs, etc. , you can go through the formalities of medical treatment in different places in the medical insurance agency of the insured place, and you can be reimbursed online for hospitalization in the designated medical insurance hospital within the city where you live. However, it is limited to critical and difficult diseases that cannot be diagnosed and treated by local medical technology and equipment. Moreover, for online settlement, individuals need to pay 10% first, and the rest will be reimbursed according to the reimbursement standard of tertiary medical institutions of residents' medical insurance in our city. Individuals who fail to be hospitalized in medical institutions outside the city according to the regulations shall pay 40% first, and the rest shall be reimbursed according to the reimbursement standard of tertiary medical institutions in the basic medical insurance for residents in our city.

Legal basis:

Article 26 of People's Republic of China (PRC) Social Insurance Law

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29 of People's Republic of China (PRC) Social Insurance Law

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.