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Can I be hospitalized if I press my social security card?
In the actual use of health insurance, while deducting the health insurance card, it will be directly within the system, the reimbursement, out-of-pocket expenses together with the amount of the deduction. In the bill returned by the hospital, the actual amount of out-of-pocket expenses and reimbursements will be listed in addition to the itemized payment details.
Article 28 of the Social Insurance Law stipulates that medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical service facilities, as well as those for emergencies and resuscitations, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Article 29 of the Social Insurance Law stipulates that the portion of a participant's medical expenses that should be paid out of the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
Social insurance administrative departments and health administrative departments should set up a system for settling medical expenses for medical treatment in other places, so as to make it easier for insured persons to enjoy basic medical insurance treatment.
Medicare is one kind of social security, belonging to the universal nature of the social welfare, mainly used to go to the hospital to see a doctor for treatment, buying drugs and other medical expenses reimbursement. There are three main types of health insurance, depending on the group of participants: urban workers' health insurance, urban and rural residents' health insurance, and new rural cooperative.
It's important to note that although there are individual contributions to the urban and rural residents' health insurance and the new rural cooperative, the money goes into the integrated account. Because most of the time the money to buy drugs with health insurance is paid with the personal account, so people enrolled in these two types of health insurance, in addition to some of the medicines prescribed by the health insurance, usually can not use the health insurance to buy drugs.
The form of reimbursement for medical insurance is very similar to that of medical insurance, with a deductible (called the "starting line" in medical insurance), a fixed amount of coverage (called the "ceiling line" in medical insurance), and a specified reimbursement rate. The formula is as follows: reimbursement = (total expenses - threshold - out-of-pocket expenses) x reimbursement rate.
Medicare reimbursement for treatment costs is mainly limited to the medical insurance catalog, only in the medical insurance catalog of drugs, treatment items can be reimbursed. But in reality, each region has special rules for treatments that are not included in the medical insurance catalog.
Article 30 of the Social Insurance Law stipulates that the following medical expenses shall not be covered 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 the first payment.
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