Types and reimbursement ratio of medical insurance

The types of medical insurance are generally divided into employee medical insurance, new rural cooperative medical care and basic medical insurance for pure residents, supplemented by large medical expenses assistance, supplementary medical insurance, serious illness insurance, long-term care insurance, medical assistance and medical poverty alleviation insurance. The reimbursement rate varies from place to place. For example, the outpatient service of the second-level designated medical institution of Changsha employee medical insurance is paid at the rate of 60%, and the specific ratio is asked by the local people's social security bureau.

The scope of medical insurance includes:

1. medical insurance drug list: it is divided into Class A and Class B. All drugs in Class A list can be included in the scope of reimbursement, and then reimbursed according to the prescribed proportion; Class B drugs require individuals to pay a certain proportion, and the rest are included in the scope of reimbursement, and then reimbursed according to the prescribed proportion;

2. Catalogue of diagnosis and treatment items: diagnosis and treatment items that are necessary for clinical diagnosis and treatment, safe and effective, and have appropriate expenses, and the charging standard has been formulated by the price department. Such as: registration fee, medical record fee, beauty project, cosmetic project, etc. Cannot be reimbursed;

3. Catalogue of medical service facilities: the service facilities provided by designated medical institutions and necessary in the process of receiving diagnosis, treatment and nursing. For example, ambulance, hospital escort fee, washing fee and entertainment fee can not be reimbursed.

The reimbursement process of hospitalization medical insurance includes:

1, go to the designated medical insurance hospital for medical treatment, and register with social security card and medical insurance card;

2. When discharged from the hospital, the medical insurance card will be directly used for settlement, and the reimbursement part will be settled by the medical insurance center and the hospital, and the self-funded part will be paid.

To sum up, social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. It is undertaken by the government and implemented and managed by economic, administrative and legal means. Social medical insurance consists of basic medical insurance and large medical assistance, enterprise supplementary medical insurance and individual supplementary medical insurance.

I hope the above content can help you. Please consult a professional lawyer if you have any other questions.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.