How to use medical insurance and under what circumstances can it be reimbursed?

Medical insurance means that individuals use various insurance tools to build their own medical security system. Personal medical insurance includes social medical insurance and commercial medical insurance. So how to use medical insurance, and under what circumstances can it be reimbursed? Now, the answer is only from social medical insurance.

1. According to the Notice of the Ministry of Labor and Social Security and other departments on Printing and Distributing the Interim Measures for the Administration of Designated Medical Institutions of Basic Medical Insurance for Urban Employees (No.1999 issued by the Ministry of Labor and Social Security), the insured persons can purchase medicines at designated medical institutions or hold prescriptions at designated retail pharmacies independently. In addition to emergency and first aid, the expenses incurred by the insured in non-selected designated medical institutions shall not be paid by the basic medical insurance fund. Therefore, if employees really can't go to the selected hospital for treatment, they will go to a nearby hospital for treatment and hold a hospital emergency certificate, and their medical expenses can be paid by the basic medical insurance fund according to regulations. Moreover, what needs to be specially explained here is that any emergency and first-aid medical treatment that belongs to accidental injuries, even in designated medical institutions, cannot directly use the medical insurance card to pay the expenses, so as to avoid the treatment of traffic accidents and the treatment of work-related injury insurance, because these two types of medical expenses are reimbursed through another channel.

2. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. Employers and individuals pay insurance premiums according to a certain proportion and establish social medical insurance funds to pay medical expenses for employees. Individuals only need to pay the money to the relevant departments of their units or enterprises every month, or they can pay it at the local social security bureau.

3. Personal medical insurance is a supplement to social insurance. Because social insurance has a minimum payment, no reimbursement at one's own expense, and exclusive liability, it is very necessary to buy personal medical insurance, which can provide full and comprehensive protection.

4. The advantage of social medical insurance lies in enjoying treatment according to uniform standards. The same access conditions, the same fees, the same treatment, there is no difference between high and low. The employee's outpatient expenses can be deducted from his personal account and paid by the employee after deduction. The hospitalization expenses of employees shall be reimbursed in proportion: 1 1,000 yuan, and 86% of the expenses shall be reimbursed by tertiary hospitals; 65,438+0,000 to 20,000 yuan, and 88% of the expenses are reimbursed by tertiary hospitals; 20,000 to 40,000 yuan, and 92% of the expenses are reimbursed by tertiary hospitals. If employees have not been sick for several years in a row, personal account funds can be accumulated. In social medical insurance, there is a basic deductible line for each hospitalization, namely, the first-level hospital 500 yuan, the second-level hospital 750 yuan, and the third-level hospital 1 1,000 yuan. These expenses need to be borne by employees themselves. Class A drugs and Class B drugs are reimbursed in proportion, and imported drugs are not reimbursed. If the amount exceeds 40 thousand, you have to pay for it yourself