Is hospitalization for fracture covered by medical insurance? How much can I reimburse?

The hospitalization of fracture belongs to the scope of medical insurance, and a certain proportion of medical expenses can be reimbursed.

The specific reimbursement ratio and amount may vary according to the provisions of different regions and different medical insurance systems, generally including the following aspects:

1. Types of medical insurance. Different types of medical insurance may have different reimbursement rates and standards. For example, the basic medical insurance for urban residents and the basic medical insurance for urban and rural residents may have different reimbursement ratios and limits;

2 hospitalization expenses, including hospitalization expenses, operation expenses, medicine expenses, examination expenses, etc. Generally speaking, medical insurance will reimburse a certain proportion of hospitalization expenses, and the specific proportion and limit may vary according to the provisions of different regions and different medical insurance systems;

3. Reimbursement ratio. Medical insurance can reimburse different medical items or expenses in different proportions. For example, hospitalization expenses may be reimbursed in a higher proportion, while some high-end medical projects may be reimbursed in a lower proportion.

Fracture hospitalization reimbursement process generally includes the following steps:

1, hospitalized. After the fracture, you need to go to the hospital for hospitalization and receive corresponding treatment and examination according to the doctor's instructions;

2. Pay the fee. During hospitalization, you need to pay the corresponding medical expenses, including hospitalization expenses, operation expenses, medicine expenses, examination expenses, etc.

3. Apply for reimbursement. After the treatment, patients can apply to the hospital medical insurance window or the local social security agency for reimbursement of medical expenses. Need to submit relevant medical insurance cards, hospitalization invoices, medical records and other related materials to apply for reimbursement of medical expenses;

4. Review reimbursement. The hospital or social security agency shall review the medical expenses applied for and determine the reimbursement amount and proportion according to the local medical insurance policy;

5. After receiving the reimbursement, the hospital or social security agency will directly transfer the reimbursement to the applicant's bank card or provide cash to receive it.

To sum up, when applying for reimbursement of medical expenses, you need to provide relevant information and proof to ensure that the application process conforms to the local medical insurance policy.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.