Is Hepatitis B Insurance Reimbursable

Hepatitis B treatment costs are generally reimbursed. Anti-hepatitis B virus, if the condition is mild, you can choose interferon. If liver function is severely impaired, jaundice and other symptoms, you can choose oral anti-HBV drugs, including lamivudine, entecavir, tenofovir and so on, as prescribed by the doctor. Hepatitis B treatment is reimbursed at different rates, with distinctions made between social health insurance, municipal health insurance, and provincial health insurance. Therefore, patients need to be clear that hepatitis B treatment is determined on a sliding scale and is not fully reimbursed. And whether medicines and therapeutic drugs are eligible for reimbursement under the health insurance is determined based on the medicines, tests, treatments, and standard accommodation fees. In the health insurance catalog. Items beyond the scope of this catalog that are not covered by health insurance reimbursement should be paid out of pocket. It is generally recommended not to drink alcohol after hepatitis B vaccination. Also pay attention to rest, do not stay up late, do not overwork, try not to smoke.

I, whether commercial insurance can reimburse the cost of hepatitis B treatment

Beginning in 2018, chronic hepatitis B virus infection (i.e., hepatitis B), anti-rejection treatment after lung transplantation, both types of illnesses are included in the reimbursement of special illnesses under the Employee's Health Insurance and Resident's Health Insurance.

Second, the reimbursement conditions

1. Employees participating in the health insurance;

2. Individuals participating in the second class of the employee health insurance;

3. Participants in the municipal residents' health insurance.

Three, the scope of reimbursement

Participants in the outpatient treatment of their choice of designated medical institutions incurred disease-related examination, treatment costs and drug costs are included in the scope of reimbursement (within the limits of the drugs are not subject to medical insurance drug list).

Four, reimbursement rate

1. Limit standard: chronic hepatitis B limit standard is 6,000 yuan/year, for the insured person in the year of the new special disease is less than a year, reimbursement limit is calculated according to the actual number of months of the new special disease.

2. Reimbursement ratio: the outpatient medical expenses of special diseases of the insured are shared in the following proportions:

3. Reimbursement ratio of hepatitis B medical insurance for employees:

4. Reimbursement ratio of hepatitis B medical insurance for residents:

There is no reimbursement threshold for outpatient treatment of the medical expenses covered by the medical insurance, the reimbursement ratio of 80% of the first level of health care, 60% of the second level, 40% of the third level, and the annual reimbursement limit of 1000 yuan. 40%, the annual reimbursement limit is 1000 yuan/year, person, at the same time suffering from two or more special diseases chronic diseases, each additional one, the annual reimbursement limit increased by 200 yuan.

V. How to reimbursement

1. Hepatitis B patient participants must go to the designated hospital for outpatient treatment;

2. Inspection, treatment costs and drug costs incurred are included in the scope of reimbursement;

3. Outpatient special disease medical expenses are calculated cumulatively on an annual basis.

Sixth, note

Commercial medical insurance only provides reimbursement for the actual medical expenses incurred by the insured, and the scope of reimbursement is different for different commercial medical insurance. Expense reimbursement type insurance it can reimburse hospitalization medical expenses, but the scope of reimbursement varies from product to product. Some commercial medical insurance contracts stipulate that actual medical expenses must be covered by social security in order to be reimbursed.

If you have already received compensation from the social security or other social welfare organizations, the insurance company will only pay the remaining portion of the cost, and if the social security is not able to reimburse you for the cost of imported medicines, special medicines, intensive care units, etc., this type of commercial medical insurance will not be able to reimburse you, and will only be able to reimburse the portion of the costs that you have to pay proportionally after being reimbursed by the social security. On the other hand, some commercial medical insurance policies provide for the reimbursement of reasonable expenses incurred by the insurer on a pro rata basis or after a certain deductible.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China (PRC) states that medical expenses that are in line with the basic medical insurance drug list, diagnostic and treatment items, standards of medical services and facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 30-The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid from the Workers' Compensation Insurance Fund;

(2) those that should be borne by a third party;

(3) those that should be borne by the public ****health;

(4) those who seek medical treatment outside China.

Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after making the payment in advance.

The Social Insurance Law of the People's Republic of China

Article 2-The State establishes a social insurance system for basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance, maternity insurance, etc., and guarantees the right of citizens to receive material assistance from the State and society in accordance with the law in the event of old age, illness, industrial injury, unemployment or childbirth.

Article 26-The standards of treatment for basic medical insurance for workers, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28-Medical expenses in accordance with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with the state regulations.