Subjectivity of law:

Medical insurance, like other types of insurance, collects medical insurance premiums from people threatened by diseases in advance by contract, establishes a medical insurance fund, and reimburses medical expenses incurred when the insured falls ill and goes to a medical institution for treatment.

1. What are the reimbursement conditions for medical insurance

1. The insured person must go to the designated medical institutions of basic medical insurance to seek medical treatment and purchase medicines, or purchase medicines from designated retail pharmacies determined by social insurance institutions with medical prescriptions issued by doctors in designated hospitals.

2. The medical expenses incurred by the insured in the process of seeing a doctor must conform to the scope and payment standards of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards, before they can be paid by the basic medical insurance fund according to regulations.

3. among the medical expenses that the insured must meet the payment scope of the basic medical insurance, the part above the threshold and below the maximum payment limit of the social medical pooling fund shall be paid by the social medical pooling fund in a unified proportion.

2. Precautions for reimbursement of medical insurance

1. Pay attention to seeing a doctor and buying medicine at a designated institution

Medical insurance has a designated institution, and it can only be reimbursed if you go to a designated hospital for medical treatment and hospitalization; If you go to a non-designated medical institution, there is no way to reimburse the treatment expenses, so you can only bear them yourself. Buying medicine is also the case. Only designated pharmacies with medical insurance can swipe their medical insurance cards to buy medicine, and other pharmacies can only pay for it themselves.

2. Don't transfer to other hospitals without permission

Some diseases can't be seen in designated medical institutions, and you need to be transferred to other hospitals for treatment. You must apply for a referral first, and you can only be reimbursed if the procedures are complete. There is often a gap in the proportion of reimbursement. Generally speaking, the higher the level of hospital treatment, the lower the proportion of reimbursement.

3. Medical insurance has a deductible line, which can only be reported after crossing the line.

There is a deductible line for medical insurance, and you can only reimburse yourself after the money you paid first reaches that amount. For example, a certain place stipulates that the outpatient deductible is 18 yuan, and only when the total amount of outpatient medical treatment exceeds 18 yuan in one year can it be reimbursed. At the same time, medical insurance also has a cap line, and the excess money cannot be reimbursed.

4. Some drugs cannot be reimbursed

Medicare-reimbursed drugs are specific, and only drugs in the medical insurance catalogue can be reimbursed, while drugs outside the medical insurance catalogue cannot be reimbursed, such as many expensive imported innovative drugs and patented drugs. So communicate with the doctor before taking the medicine. If you want to save money, you should use the medicine in the catalogue.

5. Some special surcharges can't be reimbursed

for inpatient rooms, or for special doctors and nurses and other additional services, which can't be reimbursed, so you have to pay for them yourself.

6. Pay attention to the time limit for reimbursement, and don't exceed the time limit.

When you leave the hospital, you must settle all kinds of expenses with your social security card. If you can't settle them immediately under special circumstances, you can take the documents and vouchers and go to the medical insurance department to reimburse the medical expenses manually later. If you exceed the time limit, you can only bear these expenses yourself.

It is good to have medical insurance, but not all of them can be reported, and many fights can be reported in any hospital. You still have to do it when you go to see a doctor. Legal objectivity:

Article 29 of the Social Insurance Law of the People's Republic of China

The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by the social insurance agency, medical institutions and pharmaceutical trading units.

the social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in different places, so as to facilitate the insured to enjoy the basic medical insurance benefits.