The reimbursement scope of overall medical insurance includes: emergency and rescue medical expenses; Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund; Medical expenses that meet the basic medical insurance drug list, etc. Because of suicide, self-mutilation, alcoholism and other reasons, it does not belong to the scope of reimbursement of overall medical insurance. Social security medical insurance consists of two parts, one is basic medical insurance, and the other is serious illness medical co-ordination. The two are a whole. When the reimbursement expenses exceed the limit, the reimbursement of basic medical insurance will be converted into the overall reimbursement of serious illness medical care. The scope, proportion and basic medical insurance of reimbursement for serious illness are very different.

Overall medical insurance reimbursement scope:

1, outpatient and emergency medical expenses: The medical expenses that meet the requirements of basic medical insurance for employees in the current year (65438+ 10/kloc-0+February 3 1) totaled more than 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.

4. Outpatient medical treatment for three special diseases: when the insured suffers from malignant tumor radiotherapy and chemotherapy, renal dialysis, kidney transplantation and other diseases and needs to take anti-rejection drugs in the outpatient department, the insured will see a doctor.

Third-level designated hospitals issue "Certificate of Disease Diagnosis", fill in the "Declaration and Approval Form for Special Diseases of Medical Insurance", and report to the District Medical Insurance Center for approval and filing.

Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.

Hospitalization: After paying medical insurance for 20 years, you can enjoy medical insurance reimbursement after retirement.

In daily life, the national law stipulates that employers must provide protection for workers in society, which is reflected in the social insurance stipulated by our laws. Of course, if we want to supplement social security now, the conditions are very serious, and there can be no insurance fraud, otherwise the crime of fraud is also stipulated in the criminal law.

I hope the above content can help you. If in doubt, please consult a professional lawyer.

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.