Scope and standard of medical insurance reimbursement

Scope and standard of medical insurance reimbursement:

In terms of social security, the scope of medical insurance reimbursement is the items in the medical insurance catalogue, including medicines, medical treatment items and medical service facilities.

1. Drugs are divided into Class A, Class B and Class C, among which Class A drugs are necessary for clinical treatment and widely used, and the drug expenses of these drugs are reimbursed according to the proportion stipulated by medical insurance. Class B drugs are paid a certain proportion first, and then reimbursed according to medical insurance. The specific reimbursement ratio varies from place to place.

2, diagnosis and treatment project refers to the hospitalization, the use of medical instruments, equipment and medical materials, mainly in two ways, the whole project is included in the scope of medical insurance reimbursement, according to the provisions of the proportion of payment. Part of the overall planning project is to pay a part in advance and then reimburse it according to the prescribed proportion.

3, medical service facilities standards, refers to the hospital bed fees, outpatient and emergency observation bed fees, etc., the scope and standards of reimbursement vary from place to place.

For example:

1, outpatient reimbursement rate is 50%, hospitalization Qifubiaozhun is divided into hospitals. One-year qifubiaozhun is 700 yuan, one-year qifubiaozhun is 600 yuan and one-year qifubiaozhun is 500 yuan.

2. The reimbursement rate of Class A and general diagnosis and treatment is 85%, and the reimbursement rate of Class B drugs is 75%.

3 chronic diseases, special diseases, serious diseases, the annual minimum payment standard for 700 yuan, 80% for general diagnosis and treatment of class A, 75% for class B and 70% for advanced treatment.

In the case of commercial insurance, the reimbursement scope and standard of medical insurance are different, and the requirements of different types of insurance are subject to the terms. For example, the reimbursement scope of million yuan medical insurance includes general medical insurance and critical illness medical insurance, including hospitalization, special outpatient service, outpatient emergency service and outpatient surgery before and after hospitalization. Some million yuan medical insurance also includes proton heavy ion medical insurance, reimbursement of specific drug expenses, critical illness diagnosis allowance and critical illness hospitalization allowance.

The compensation standard is divided into general medical insurance, and the deductible is 1 0,000, which is equivalent to more than 1 0,000. After deducting social security reimbursement and exemption, it can be reimbursed by 1 0,000%. Serious illness usually has no deductible, and social security reimbursement directly reimburses 65,438+0,000%.