The reimbursement standards for medical insurance mainly include reimbursement scope, reimbursement proportion and reimbursement limit, etc. These standards are designed to ensure that the insured can use the medical insurance fund reasonably and effectively and obtain necessary medical services.

I. Scope of reimbursement

The scope of reimbursement for medical insurance mainly includes expenses such as drugs, diagnosis and treatment items and medical service facilities that meet the requirements. Specifically, the expenses of drugs, examination, treatment and surgery used by the insured in designated medical institutions can be included in the scope of reimbursement if they meet the medical insurance catalogue and regulations. At the same time, some special diagnosis and treatment items, such as radiotherapy and chemotherapy for malignant tumors and renal dialysis, are usually included in the scope of medical insurance reimbursement.

ii. reimbursement ratio

the proportion of medical insurance reimbursement varies according to different regions, different types of medical insurance and different types of expenses. Generally speaking, the medical insurance foundation reimburses the medical expenses that meet the requirements according to a certain proportion, which is usually between 5% and 9%. At the same time, for some special people, such as poor people and seriously ill patients, the proportion of medical insurance reimbursement may increase.

III. Reimbursement Limit

There is still a certain limit for medical insurance reimbursement, that is, the medical insurance fund has a maximum payment limit for medical expenses reimbursement of insured persons. This limit varies according to the type of medical insurance, region and other factors. Generally speaking, there is a maximum reimbursement amount every year or every time you see a doctor. Medical expenses exceeding this limit will not be reimbursed by the medical insurance fund.

In addition, it should be noted that medical insurance reimbursement is also affected by some other factors, such as the location, time and mode of medical treatment. For example, seeking medical treatment in non-designated medical institutions or failing to go through the referral procedures as required may affect the proportion or limit of medical insurance reimbursement.

To sum up:

The standard of medical insurance reimbursement mainly includes the scope, proportion and limit of reimbursement. When seeking medical treatment, the insured should understand and abide by the medical insurance policies and regulations, choose designated medical institutions for medical treatment, and rationally use medical insurance funds to ensure that they can obtain necessary medical services.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

stipulates:

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.

Article 3 of the Social Insurance Law of the People's Republic of China

stipulates:

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(1) Those that should be paid from the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) It shall be borne by public health;

(4) seeking medical treatment abroad.