Social security and medical insurance reimbursement scope

According to the provisions of the Social Insurance Law, as long as it meets the standards of the basic medical insurance drug list, first aid and rescue medical expenses, diagnosis and treatment items and medical service facilities, it can be paid from the basic medical insurance fund in accordance with state regulations. Among them, the reimbursement scope of social medical insurance mainly includes the following points: 1, drug reimbursement of basic medical insurance.

Class A and B drugs included in the basic medical insurance coverage can be reimbursed.

2, the basic medical insurance treatment project reimbursement

The scope of basic medical insurance payment items must be determined in accordance with the scope of basic medical insurance diagnosis and treatment items stipulated by the state. The diagnosis and treatment items that are part of the expenses paid by the basic medical insurance can be paid by the insured in advance and then paid in accordance with the provisions of the basic medical insurance.

3. Reimbursement of basic medical service facilities

The reimbursement scope of medical service facilities of basic medical insurance covers the service facilities that the insured person must live in during the process of diagnosis and treatment, including bed fees for outpatient and emergency observation and bed fees for hospitalization. For some referral transportation expenses, emergency transportation expenses, infant incubator expenses, food incubator expenses, nursing expenses and escort expenses, the basic medical insurance fund cannot reimburse them.

What's the difference between residents' medical insurance and employees' medical insurance?

The differences between employee medical insurance and resident medical insurance are as follows:

1, different insured objects

Medical insurance for employees: the insured objects are relatively narrow, mainly employees of enterprises and institutions, retired insured employees or flexible employees.

Residents' medical insurance: the coverage is wider, from children to the elderly, and people who have not participated in employee medical insurance can buy residents' medical insurance.

2. The payment entities are different.

Employee medical insurance: it is divided into two parts: unit payment and individual payment, which are handled by the unit, one part of the unit Jiaotong University and a small part of the individual.

Medical insurance for residents: All expenses shall be borne by individuals.

3. The payment amount is different

Employee medical insurance: the amount is relatively high, and it is paid in a certain proportion every month, and the proportion varies from place to place. For example, the first-class medical insurance in Shenzhen, the company bears 5.2%, and the individual pays 2%, with a total amount of at least 3,000 yuan per year.

Residents' medical insurance: the payment is small, generally only two or three hundred yuan.

Legal basis: social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.