Calculation formula of medical insurance reimbursement

The calculation formula of medical insurance reimbursement = total cost-deductible line-self-paid part of drugs and examinations * reimbursement ratio. Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance institution will give certain economic compensation. The specific provisions of medical insurance reimbursement are as follows:

1. Medical treatment and drug purchase in medical institutions and pharmacies specified by medical insurance can be reimbursed, and emergency expenses incurred by people participating in medical insurance in non-designated medical institutions can also be reimbursed;

2. Only drugs purchased in the basic medical insurance catalogue can be reimbursed. All Class A drugs are reimbursed, Class B drugs are partially reimbursed, and Class C drugs cannot be reimbursed;

3. Only those who meet the scope of basic medical insurance diagnosis and treatment projects can be fully reimbursed or partially reimbursed. ;

4 service facilities in line with the basic medical insurance medical service facilities standard range, can be reimbursed. It mainly includes hospital bed fees and emergency and outpatient observation bed fees, such as nursing fees and meals, which cannot be reimbursed.

Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency medical expenses, and 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.

Twenty-third employees should participate in the basic medical insurance for employees, and the employer and employees should jointly pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.