The scope of reimbursement is as follows: 1. Only dental treatment fees, surgical fees and other treatment expenses are reimbursed.

2. If the patient is admitted to the hospital due to medical needs and meets hospitalization standards, except for the cost of dentures, which cannot be paid by the medical insurance pooling fund, other expenses can be settled according to medical insurance regulations.

3. Dental treatment surgeries such as tooth extraction and filling are covered by medical insurance. For medical treatment at the dental clinic of the hospital, the medical insurance reimbursement rate is 50% of the cost above 1,800 yuan.

Dentures and medical beauty treatments are not included in the scope of reimbursement.

Whether dental care is reimbursable depends mainly on what aspect is being looked at.

Because not all dental items are covered by basic medical insurance.

Usually dental treatment items are covered by medical insurance, while dental cosmetic items are not.

The main things that are covered by medical insurance include fillings (including basic materials and treatment fees), tooth extractions, and the treatment of periodontal disease, gingivitis and other dental diseases; those that are not covered by medical insurance include orthodontics, veneers, and tooth cleaning.

, porcelain teeth, dental implants, etc.

New regulations on medical insurance: 1. Starting from 2023, there will be no cap on outpatient benefits for employees. Currently, the maximum payment limit for outpatient (emergency) outpatient (emergency) outpatient expenses incurred by employees insured in this city within a year that are in line with the statutory payment of this city’s basic medical insurance is:

20,000 yuan, any excess of 20,000 yuan will be borne by the individual.

Starting from January 1, 2023, there will no longer be a maximum payment limit for outpatient medical insurance for employees, and the reimbursement ratio for less than 20,000 yuan will remain unchanged; 60% will be reimbursed for employees with more than 20,000 yuan, and 80% will be reimbursed for retirees (including unified supplementary medical care for retirees)

insurance), there is no upper limit.

It is expected to benefit 170,000 insured persons every year and reduce the burden of insured persons by approximately 1 billion yuan.

2. From September 1, personal accounts cannot be withdrawn freely. To achieve targeted use, in accordance with the requirements for basic medical insurance fund management, personal account funds should be earmarked for special use.

Starting from September 1, 2022, personal account funds will be subject to bookkeeping management, and insured persons cannot withdraw them freely. They will be used in a targeted manner and will be mainly used to pay the medical expenses incurred by insured employees in designated medical institutions or designated retail pharmacies.

The funds in personal accounts that have been transferred to the special passbook for medical insurance before September 1st can still be withdrawn and used in cash at any time in the future.

3. Improve the personal account accounting method, and the part paid by the unit will be fully included in the overall fund. Starting from September 1, 2022, all basic medical insurance premiums paid by the employer will be included in the overall fund, and all basic medical insurance premiums paid by current employees will be included in the overall fund.

into a personal account, the payment ratio remains unchanged; the personal account of retirees is transferred from the overall fund according to the fixed amount, and the current standards are still followed. Those under 70 years old (exclusive) are transferred at 100 yuan/month, and those over 70 years old are transferred at 110 yuan/month.

enter.

4. Personal accounts can be used for family financial assistance from December 1, 2022. From December 1, 2022, spouses, parents, and children participating in this city’s basic medical insurance will be allowed to use family members’ personal account funds to pay for themselves.

Relevant expenses incurred by and economic recipients that comply with the regulations on the scope of use of personal accounts, and the personal account can be used to pay for the basic medical insurance and long-term care insurance for urban and rural residents in this city, and purchase supplementary medical care in this city for myself and the recipients.

Insurance (currently specifically Beijing Puhui Health Insurance).

5. Improve the level of critical illness insurance, and the deductible for employee critical illness insurance will be reduced to 30,404 yuan in 2022. In order to further reduce the medical cost burden of employees with serious illness, starting from 2022, the deductible for employee critical illness insurance will be reduced from 39,525 yuan to 30,404 yuan.

After the insured person enjoys the benefits of the urban employee basic medical insurance, the accumulated personal out-of-pocket medical expenses for outpatient and hospitalization within a year that exceed the minimum payment standard will be "secondary reimbursed" by the urban employee critical illness medical insurance.

60% of the portion above and below the minimum payment standard of 50,000 yuan (i.e. 30,404 yuan to 80,404 yuan) will be reimbursed, and 70% of the portion above 50,000 yuan (i.e. 80,404 yuan) will be reimbursed, with no upper limit.

It is expected to benefit 35,000 insured persons every year and reduce the burden of insured persons by 120 million yuan.

Legal basis: Article 26 of the "Social Insurance Law of the People's Republic of China" The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations.

Article 27 If an individual who participates in the basic medical insurance for employees reaches the legal retirement age and has paid cumulative contributions for the number of years specified by the state, he will no longer pay basic medical insurance premiums after retirement and will enjoy basic medical insurance benefits in accordance with the regulations of the state;

Yes, you can pay until the number of years specified by the state.

Article 28 Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.