Reimbursement standard of bed fee medical insurance

Generally living in a double ward or a single ward, you have to bear the expenses beyond the scope of medical insurance reimbursement. For example, the hospital bed fee is reported to 40 yuan every day, and the double ward is reported to 70 yuan every day, so the extra beds will be 30 yuan.

Specifically:

Social security can reimburse bed fees. However, employees who seek medical treatment in non-designated medical institutions or do not meet the basic medical insurance payment standards during medical treatment will not be reimbursed.

For example, refer to the second point of Article 2 of the Settlement Measures for Urban Workers' Basic Medical Insurance in Shanghai, and settle the medical expenses for outpatient serious illness and family beds.

Settlement of medical expenses for outpatient serious illness and family sickbed

1, the medical expenses of serious illness and family sickbed in outpatient department of workers shall be paid by the basic medical insurance pooling fund and additional funds, and shall be accounted by the designated medical institutions; The expenses paid by the individual medical account are deducted from the balance funds of the individual medical account over the years. Bookkeeping and medical expenses deducted from personal medical accounts shall be settled by designated medical institutions to the local district and county medical insurance offices; The rest of the medical expenses shall be collected from employees by designated medical institutions.

2. Family sickbed medical treatment. If the bed has been built for less than 6 months, the designated medical institution shall apply for medical expenses settlement when withdrawing the bed; If the bed has been built for more than 6 months, the designated medical institution shall apply for the settlement of medical expenses every 6 months or when the bed is dismantled.

3, workers for family sickbed medical treatment, designated medical institutions can charge prepaid fees according to their illness. The specific standards shall be formulated separately by the Municipal Health Bureau and the Municipal Medical Insurance Bureau.

China medical insurance reimbursement regulations:

According to the basic requirements of the payment of basic medical insurance benefits in China, the insured person who goes to the medical insurance institution to reimburse the medical expenses incurred by himself for medical treatment generally meets the following conditions:

(1) The insured must go to the designated medical institution of basic medical insurance or to the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital.

(2) The medical expenses incurred by the insured in the process of medical treatment must conform to the basic medical insurance drug list, diagnosis and treatment items, the standard scope of medical service facilities and payment standards, and be paid by the basic medical insurance fund according to regulations.

(III) Among the medical expenses that the insured meets the scope of payment of basic medical insurance, the part that is higher than the Qifubiaozhun of the social medical co-ordination fund and lower than the maximum payment limit shall be paid by the social medical co-ordination fund in a unified proportion.

Reimbursement ratio

1, outpatient and emergency medical expenses: the medical expenses that meet the requirements of basic medical insurance in the year (11October1February 31February) exceeded 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.

4. Outpatient medical treatment for three special diseases: when the insured suffers from malignant tumor radiotherapy and chemotherapy, renal dialysis, kidney transplantation and other diseases and needs to take anti-rejection drugs in the outpatient department, the insured will see a doctor.

Two, three designated hospitals according to the "disease diagnosis certificate", fill in the "medical insurance special disease declaration and approval form", submitted to the district medical insurance center for approval.

Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.

5. Hospitalization.

After paying medical insurance for 20 years, you can enjoy medical insurance reimbursement after retirement.

The proportion of medical insurance reimbursement varies from place to place. Please refer to local policies for details.

After medical insurance hospitalization, the hospital bed fee can be reimbursed according to the prescribed amount, and the general bed fee in tertiary hospitals is basically within the prescribed amount. However, there will be a certain percentage of bed fees for advanced beds or private beds that exceed the regulations at their own expense.

Legal basis:

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

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Article 4 Employers and individuals who pay social insurance premiums according to law in People's Republic of China (PRC) have the right to inquire about payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services.

Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.

Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should 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.

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.