What are the scope of medical insurance reimbursement in social security?

The scope of medical insurance reimbursement conforms to the medical expenses paid by the basic medical insurance fund, and shall be reimbursed according to the list of basic medical insurance drugs, the list of diagnosis and treatment items, the scope of service facilities and the payment standard stipulated by this Municipality.

At present, the price of national medical insurance drugs has changed. Please see here: 2020 national medical insurance drug list is newly released! The medicine you buy will be reduced in price! 》

What are the conditions for social security not to be reimbursed?

1, maternity insurance is not reimbursed:

1) The expenses incurred by going abroad or having children in Hong Kong, Macao and Taiwan will not be reimbursed.

2) Reimbursement beyond the prescribed reimbursement period will not be reimbursed.

3) Those who have not paid maternity insurance 1 year, or have stopped maternity insurance during production, will not be reimbursed.

4) Incomplete materials required for reimbursement shall not be reimbursed.

2. Medical insurance will not be reimbursed:

Medical insurance is the highest utilization rate in social security reimbursement, so there are many restrictions on the amount and scope of reimbursement.

Simply put, medical insurance reimbursement restrictions include two fixed points, three directories, deductible line, capping line, reimbursement ratio, capping line and so on.

In addition, under the following special circumstances, medical insurance is not reimbursed.

Seek medical treatment by oneself

For example, you don't go to a designated hospital for medical treatment, or you don't apply for a referral form according to regulations.

Service fee during treatment

Such as home visits, meals, nutrition, blood transfusion, cooling and heating.

Intentional injury causes medical expenses.

Medical expenses caused by car accidents, fights, alcoholism, etc.

Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;

Expenses that should be paid from the industrial injury insurance and maternity insurance funds.

Medical expenses that should be borne by a third party.

Dad concluded that as long as conditions permit, in addition to medical insurance, it is best for everyone to configure a commercial insurance and add a firewall to themselves and their families.