Job Recruitment Website - Social security inquiry - Maternity check-up and medication during pregnancy are not covered by medical insurance reimbursement.
Maternity check-up and medication during pregnancy are not covered by medical insurance reimbursement.
The specific reasons are as follows:
1, because pregnancy is not a disease, prenatal examination is not covered by medical insurance reimbursement. The medical insurance card is mainly used to pay for medical treatment due to illness, for example, individuals pay part of outpatient and hospitalization expenses when they seek medical treatment due to illness, and pharmacies buy medicines.
2. Pre-pregnancy examination shall be reimbursed by maternity insurance, that is, the expenses of prenatal examination shall be reimbursed by maternity insurance, which is generally a one-time reimbursement after delivery. If maternity insurance and medical insurance have been merged, they can be settled by medical insurance card.
Medical insurance reimbursement process for prenatal examination:
1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;
2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;
3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;
4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.
Maternity medical insurance reimbursement standards are as follows:
1. If a pregnant woman has purchased comprehensive medical insurance, part of the cost of prenatal examination can be free when she goes to the hospital for prenatal examination;
2. Pregnant women who purchase hospitalization medical insurance can enjoy the corresponding medical insurance benefits when they are hospitalized;
3. If pregnant women buy maternity insurance, they can only enjoy the corresponding maternity insurance benefits after the birth check-up and giving birth to the baby. In the process of birth check-up, most items can be reimbursed, and at the same time, you can also receive a certain maternity allowance and enjoy maternity leave.
Medical insurance reimbursement standard:
1, residents' reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; 30% reimbursement for tertiary hospitals;
2, urban residents, in a settlement year, the medical expenses that meet the scope of reimbursement are 65,438+10,000 yuan, the threshold for tertiary hospitals is 659 yuan, the reimbursement ratio is 50%, and the upper limit is 2,000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in the first-class hospital, and the reimbursement rate is 60%;
3. You need to go back to your hometown for reimbursement, and the reimbursement rate is 35-65%, which varies according to the level of the hospital.
To sum up, "pregnancy check-up and production costs can be reimbursed through medical insurance, generally through maternity insurance costs. In other words, the cost of pregnancy test is generally carried out in outpatient department and can be reimbursed. Maternity insurance covers the expenses incurred by pregnant women during delivery in hospital. This fee can be directly reimbursed when pregnant women are hospitalized, but this pregnancy check-up fee can be reimbursed.
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.
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