202 1 Longyan medical insurance reimbursement scope

Medical insurance for urban and rural residents

1. reimbursement for general outpatient service: urban and rural residents can be reimbursed for 300 yuan (maximum 30 yuan each time) in the outpatient service of township hospitals or community health service centers;

2. Special outpatient diseases: 29 diseases such as hypertension and diabetes are listed as special outpatient diseases;

3. Hospitalization reimbursement: 90%, 75% and 45% of the hospitalization expenses in the medical insurance catalogue are reimbursed in the first, second and third-level hospitals respectively, and 35% is directly reimbursed with the social security card after being filed in the hospital outside the city (30% for unrecorded reimbursement);

4. Serious illness insurance benefits: After the reimbursement of basic medical insurance, if the accumulated personal burden of the remaining medical insurance catalogue exceeds10.5 million yuan, it will be reimbursed in stages in serious illness insurance, with the maximum payment limit of 200,000 yuan per person per year.

Medical insurance refers to the basic medical insurance premium paid in full and on time by employers and employees according to the principle of compulsory social insurance through national legislation. If it is not paid in full and on time, the basic medical insurance fund will not pay its medical expenses regardless of individual accounts.

Take the proportion of medical insurance payment in Beijing as an example: the employer pays 10% of its total payment base every month, and the employee pays 2% of his salary as a whole for serious illness+3 yuan.

Medical insurance is insurance to compensate medical expenses caused by diseases. Social insurance in which employees are provided with necessary medical services or material assistance by society or enterprises due to illness, injury or childbirth.

For example, free medical care and labor insurance medical care in China. The medical expenses of employees in China are shared by the state, units and individuals to reduce the burden on enterprises and avoid waste. If the insurance liability accident needs to be handled, the insurance premium shall be paid in proportion.

source and course

Medical insurance originated in western Europe and can be traced back to the Middle Ages. With the success of the bourgeois revolution, family workshops were replaced by large industries, and modern industrial teams emerged. Due to the harsh working environment, epidemics and industrial accidents, workers need corresponding medical care.

But their wages are low, and it is difficult for individuals to pay medical expenses. Therefore, workers in many places spontaneously organized themselves to raise some money for expenses when they were sick.

But this form is not very stable, and the scope is small, and the ability to resist risks is very low. /kloc-at the end of 0/8 and the beginning of 09, private insurance developed in western Europe and became an important way for the country to raise medical funds.

Medical insurance has the basic characteristics of social insurance, such as compulsion, mutual assistance and sociality.

Therefore, the medical insurance system is usually enforced by national legislation and a fund system is established. The expenses are paid jointly by the employer and the individual, and the medical insurance premium is paid by the medical insurance institution to solve the medical risks caused by the illness or injury of the employees.

classify

According to its nature, it can be divided into social medical insurance and commercial medical insurance.