Job Recruitment Website - Social security inquiry - Why can't Dongguan employee social security reimburse the fever clinic?
Why can't Dongguan employee social security reimburse the fever clinic?
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Take participating in the basic medical insurance for urban workers as an example;
An insured person in Lao Guo was hospitalized and incurred medical expenses within the scope of medical insurance catalogue, including 2000 yuan for class A drugs, 3000 yuan for class B drugs and 5000 yuan for class B drugs. The out-of-pocket proportion of Class B drugs is 10%, and the local deductible line is 1.300 yuan. The medical expenses did not exceed the ceiling line, and the reimbursement rate of basic medical insurance for urban workers in hospitals at this level was 80%.
The reimbursement method is: the total expenses of Class A drugs are 3,000 yuan, plus the remaining expenses of Class B drugs after deducting out-of-pocket expenses of 4,500 yuan (the out-of-pocket expenses of Class B drugs are 5,000 *10% = 500 yuan), and the medical expenses that meet the medical insurance regulations are 2,000 yuan, totaling 9,500 yuan. After deducting the deductible 1300 yuan, the expenses included in the reimbursement scope are 8,200 yuan. Then the medical expenses in Lao Guo can be reimbursed by medical insurance for 8200*80%=6560 yuan, and Lao Guo needs to bear 3440 yuan (deductible line is 1300 yuan+self-payment of Class B drugs in 500 yuan+proportional personal burden within the scope of medical insurance policy is 1640 yuan).
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