Can medical insurance be reimbursed if it is not returned?

The medical insurance is broken, and you can continue to buy medicine if there is a balance in the medical insurance card, but you can't reimburse the doctor.

The medical insurance is broken, and you can continue to buy medicine if there is a balance in the medical insurance card, but you can't reimburse the doctor.

If the insured fails to pay the medical insurance premium in full and on time as required, he will stop enjoying the medical insurance benefits from the month when he has never paid it in full and on time; If the payment is continued after the interruption, it must be based on the average salary of local employees in the previous year at the time of payment, and all the arrears during the interruption must be filled. The overdue time is included in the continuous payment time, but you can't enjoy the treatment of pooling funds during the overdue period.

If the insured stops enjoying medical insurance benefits and pays medical insurance premiums within 60 days (including 60 days), he will enjoy the benefits paid by the overall fund from the next month of payment;

Suspension of medical insurance benefits for more than 60 days to 180 days (including 180 days) to pay back medical insurance, starting from the payment month, you can enjoy the treatment paid by the overall fund three months later;

If the medical insurance benefits are suspended for more than 180 days and the medical insurance premium is paid back, it will be calculated from the month of payment and enjoy the treatment paid by the overall fund after 6 months.

If the payment is not made after the interruption, it will be regarded as re-participating in medical insurance, and the payment time before the interruption will not be included in the continuous payment time.

What items does medical insurance reimbursement include?

The classification of medical insurance reimbursement and the items included are as follows:

1, general medical insurance. It mainly includes outpatient expenses, medical expenses and inspection expenses.

2. Hospitalization insurance. Mainly the daily hospitalization expenses, hospital equipment use expenses, operation expenses, medical expenses and so on.

3. Surgery insurance. Provide all expenses incurred due to the patient's need for necessary surgery.

4. Comprehensive medical insurance. Its cost range includes all expenses such as medical treatment, hospitalization and surgery.

5. Special disease insurance. Some special diseases often bring disastrous expenses to patients, which ordinary families can't bear. Such as cancer and heart disease. The major diseases that provide protection for the insured can be single diseases, such as malignant tumors, or even some cancers in malignant tumors.

I hope the above content can help you. Please consult a professional lawyer if you have any other questions.

Legal basis: Article 28 of the Social Insurance Law conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29 of the Social Insurance Law stipulates that the part of the insured's medical expenses that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.