What items can be reimbursed for children's social security?

What items can be reimbursed for children's social security? According to the national policy, the reimbursement scope of drugs and medical treatment items of medical insurance for serious illness of students and children should refer to the reimbursement scope of current basic medical insurance.

The medical insurance for serious illness of students and children mainly pays for hospitalization expenses; Outpatient medical expenses for taking anti-rejection drugs, hemophilia and aplastic anemia after radiotherapy and chemotherapy for malignant tumor, renal dialysis and kidney transplantation (including combined liver and kidney transplantation); Emergency rescue observation and income hospitalization, medical expenses within 7 days before hospitalization observation; Medical expenses for emergency rescue and observation of death within 7 days. The medical expenses incurred must conform to the basic medical insurance of this Municipality and the medical insurance for serious illness of students and children, the catalogue of diagnosis and treatment items and the medical expenses within the scope of medical service facilities.

However, the current basic medical insurance for employees does not stipulate the drugs and treatment items used by children, especially the reimbursement of congenital diseases. So on the basis of the basic medical insurance for employees, the "Reimbursement Catalogue" was added. In other words, the Catalogue of Children's Medical Insurance Reimbursement includes two parts: the current scope of reimbursement for employees' basic medical insurance and the supplementary scope of reimbursement announced this time.

It is understood that the supplementary reimbursement scope of medical insurance for students and children with serious illness formulated and announced by the relevant state departments includes six parts: congenital diseases, diagnosis and treatment items, hospital preparations, Chinese patent medicines, western medicines and new dosage forms of western medicines. Specifically, the scope of this supplementary reimbursement includes 46 kinds of congenital diseases, 90 items of diagnosis and treatment, 16 1 drugs.

Students and children who are hospitalized or treated for special diseases shall be paid in advance by individuals when seeking medical treatment, and the medical expenses incurred shall be accounted for by designated medical institutions. At the time of settlement, the part paid by the serious illness medical insurance fund shall be settled by designated medical institutions and social insurance agencies, and the rest of the medical expenses shall be settled by individuals and designated medical institutions.

Seek medical treatment in non-designated medical institutions, except for emergency hospitalization; Injuries caused by traffic accidents, medical accidents or other accidents; Drug abuse, fighting or other illegal acts cause injuries; Treatment for suicide, self-mutilation, alcoholism and other reasons; Treatment abroad or in Hongkong, Macao Special Administrative Region and Taiwan Province Province; In accordance with the provisions of the state and this Municipality, it shall be borne by individuals.

What items of social security medical care can be reimbursed? The Social Insurance Law stipulates that medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

1, basic medical insurance drug list

The scope of basic medical insurance drugs is managed by formulating the basic medical insurance drug list. Drugs included in the drug list should be clinically necessary, safe and effective, reasonably priced, convenient to use and guaranteed by the market, and meet one of the following conditions:

(1) drugs listed in People's Republic of China (PRC) Pharmacopoeia (current edition);

(two) drugs that meet the standards of National Medical Products Administration;

(3) Drugs officially imported with the approval of National Medical Products Administration.

The following drugs cannot be included in the basic medical insurance coverage:

(1) drugs with nourishing and strengthening effects;

(2) Some animals and animal organs and dried fruits that can be used as medicine;

(3) Various wine preparations brewed with Chinese herbal medicines and Chinese herbal pieces;

(4) Fruity preparations and oral effervescent agents in various medicines;

(5) Blood products and protein products (except for special indications and first aid and rescue);

(six) other drugs that are not paid by the basic medical insurance fund as stipulated by the administrative department of social insurance.

The drug catalogue is divided into "Class A catalogue" and "Class B catalogue". The drugs in the "Class A Catalogue" are necessary for clinical treatment, widely used, with good curative effect, and the prices of similar drugs are low. The Catalogue of Category A is formulated by the state and may not be adjusted by all localities. The drugs in the "Category B Drug List" are available for clinical use with good curative effect, and the price of similar drugs is slightly higher than that in the "Category A Drug List". The "Class B Catalogue" is formulated by the state, and the overall planning areas can be adjusted appropriately. The sum of the increase or decrease in the number of varieties shall not exceed 15% of the total number of drugs in the Class B Catalogue stipulated by the state.

In principle, the drug list is adjusted every two years, and the drug lists of all provinces, autonomous regions and municipalities directly under the Central Government are also adjusted accordingly.

2, the basic medical insurance treatment project

The basic medical insurance treatment project shall meet the following conditions:

(1) Clinical diagnosis and treatment must be safe and effective, and the cost should be appropriate;

(2) The price department has set the charging standard;

(3) within the scope of designated medical services provided by designated medical institutions for the insured.

The scope of basic medical insurance to pay part of the cost of diagnosis and treatment projects is determined in accordance with the scope of basic medical insurance diagnosis and treatment projects stipulated by the state. Belong to the basic medical insurance payment part of the directory of medical treatment project costs, first by the insured according to the provisions of the proportion of self pay, and then pay according to the provisions of the basic medical insurance.

3, basic medical service facilities standards

The basic medical insurance medical service facilities refer to the life service facilities provided by designated medical institutions and necessary for the insured in the process of receiving diagnosis, treatment and nursing, mainly including the hospital bed fee or outpatient (emergency) observation bed fee. The basic medical insurance fund does not pay for living services and service facilities, mainly including:

(1) outpatient and first aid (transfer) transportation expenses;

(2) Air conditioning fee, TV fee, telephone fee, baby incubator fee and food incubator fee;

(3) Escort fee, nursing fee, washing fee and outpatient decocting fee;

(4) meals;

(5) Hospitality and other special life service expenses.

Industrial Injury Insurance "Social Insurance Law" What items can be reimbursed?

Article 38 The following expenses incurred due to work-related injuries shall be paid by the work-related injury insurance fund in accordance with state regulations:

(a) medical expenses and rehabilitation expenses for the treatment of work-related injuries;

(2) Hospitalization food subsidies;

(three) transportation and accommodation expenses for medical treatment outside the overall planning area;

(four) the cost of installing and configuring assistive devices for the disabled;

(five) life can not take care of themselves, confirmed by the labor ability appraisal committee of life care costs;

(6) One-time disability allowance and monthly disability allowance for disabled employees of Grade I to IV;

(seven) the one-time medical subsidy that should be enjoyed when the labor contract is terminated or dissolved;

(8) Funeral grants, dependent relatives' pensions and work-related death grants received by survivors of work-related deaths;

(nine) labor ability appraisal fee.

Article 39 The following expenses incurred due to work-related injuries shall be paid by the employing unit in accordance with state regulations:

(a) wages and benefits during the treatment of work-related injuries;

(two) the monthly disability allowance for disabled employees of Grade 5 and Grade 6;

(3) One-time disability employment subsidy that should be enjoyed when the labor contract is terminated or dissolved.

I am an individual who pays social security and medical insurance. What items can the hospital reimburse? I am insured. Medical insurance is in the hospital, except for my own meals and bed fees.

Can the child's social security be reimbursed if it is missed? The so-called missed payment means that the child's social security has not been paid. Of course, children can't be reimbursed if they don't pay social security. Failure to pay social security can be reimbursed. Then who wants to pay social security? What does social security use to help people reimburse? Whether it is lost or not, it can't be reimbursed.

What items need medical insurance reimbursement for social security reimbursement cases after discharge? You need to go to the local medical insurance management center or the medical insurance checkout window of designated medical institutions for reimbursement.

Procedures include: my ID card, medical insurance card, original invoice, medication list, medical records and other materials.

Medical insurance reimbursement is carried out in proportion, generally floating around 70%. The proportion and amount of reimbursement are related to their own examination and medication, medical level and other factors. For example, it is clear that Class A drugs can enjoy full coverage, Class C drugs need to bear all the costs, and Class B drugs will report 80% and bear 20% of the costs.

Can social security be reimbursed for driving test and medical examination? Of course, because they just look at your physical condition and go through a procedure like that. In reality, driving doesn't depend on your physical condition at all, as long as your limbs are not disabled.

Which items of medical insurance card can be reimbursed for physical examination can generally be reimbursed by purchasing general medical insurance, but it varies according to different insurance companies.

For example, the general medical care of Xinhua Life Insurance can be reimbursed for medical examination fees, material fees, infusion fees and other miscellaneous expenses.

At the same time, medical insurance is generally attached, and medical reimbursement depends on the insurance company.

What is the reimbursement ratio of children's social security card? The reimbursement rate is the same as others, as long as it is the same medical insurance. For example, residents' medical insurance or the new rural cooperative medical system.