Can accidental social security be reimbursed?

According to national regulations, the medical expenses caused by accidental injuries are not within the reimbursement scope of residents' medical insurance and urban workers' medical insurance. 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.

What are the scope that does not belong to medical insurance reimbursement

1, suicide and self-mutilation (except mental illness);

2. Fighting, drinking, taking drugs and causing injuries due to illegal crimes or violation of public security;

3. Belonging to the payment scope of maternity insurance or industrial injury insurance;

4. Without approval, purchasing or dispensing medicines in non-designated retail pharmacies or seeking medical treatment in non-designated medical institutions;

5, accidents, traffic accidents, medical accidents, etc., which are clearly borne by others;

6. In Hongkong, Macao Special Administrative Region and Taiwan Province Province;

7. No payment will be made according to relevant regulations. According to the relevant regulations, if there is no clear responsibility for the medical expenses borne by others, it belongs to the scope of reimbursement of urban medical insurance.

Social security card reimbursement of medical expenses:

1. When entering or leaving the hospital, you must go through the registration formalities with the medical insurance IC card at the medical insurance management window of each designated medical institution.

2. After the insured is hospitalized, the deductible line of the overall fund is divided into three grades: tertiary hospital 1000 yuan, secondary hospital 600 yuan, and primary hospital 400 yuan. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.

3, the insured due to illness need referral (hospitalization), shall be approved by the designated medical institutions (three or more) deputy chief physician or chief physician diagnosis put forward referral (hospitalization) opinions, by the unit to fill in the application form, after the approval of the designated medical institutions medical insurance management department reported to the municipal (District) social security institutions for referral (hospitalization) procedures.

4. When the designated medical institutions are discharged from the hospital, the reimbursement amount and the amount payable by individuals shall be calculated by the designated medical institutions, and the reimbursement amount shall be settled by the designated medical institutions and urban social insurance agencies, and the amount payable by individuals shall be settled by the designated medical institutions and the insured.

5. When visiting a designated hospital, show the medical insurance card to prove the identity and registration of the insured. Individuals do not need to pay first and then reimburse, and the part of medical insurance reimbursement can be directly settled by medical insurance and hospitals. Only when the account is settled, the self-funded part will be paid by the balance of the medical insurance card or cash.

legal ground

People's Republic of China (PRC) social insurance law

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.