Medical insurance can generally reimburse hospitalization expenses, but if it is similar to CT's self-funded expenses, then medical insurance cannot be reimbursed, and the insured must bear it himself. It should be noted that most medical insurance has restrictions on deductibles and quotas, so the deductible and the excess amount also need to be borne by the insured.
The purposes of medical insurance are as follows:
1, seeing a doctor, hospitalized in a designated hospital. Medical expenses that are not within the scope of medical insurance reimbursement and need to be borne by individuals can be paid with medical insurance personal accounts;
2. Vaccinate the second-class preventive immunization vaccine in designated medical institutions. Medical expenses such as cervical cancer /HPV vaccine and influenza vaccine can be paid by medical insurance personal account;
3. At the designated pharmacy. When purchasing medicines, medical devices and disinfection products, you can use the personal account of medical insurance to pay.
The scope of medical insurance reimbursement includes:
1, medical expenses during rescue;
2. Medical expenses during hospitalization;
3, surgical materials and AIDS;
4. Bed fee: according to local medical insurance standards. Except those who need to be admitted to ICU due to acute craniocerebral injury and complex visceral injury, they should be transferred to the general ward immediately after they are out of danger;
5. Rehabilitation physiotherapy fee: according to local medical insurance standards. In principle, there are no more than three kinds, and rehabilitation physiotherapy outside the scope of medical insurance will not be compensated;
6, dressing change and rehabilitation function guidance training: according to local medical insurance standards combined with disease needs;
7. Ambulance fee: calculated according to the standard approved by local health department and price department;
8. Other expenses: expenses that are not compensated according to regulations will not be compensated;
9. Continuing medical expenses: In order to close the case in advance, the insured can pay the necessary continuing medical expenses for the injured in the future in advance. Only when the discharge certificate or diagnosis certificate clearly indicates that the competent doctor needs to continue treatment, or the internal fixator is removed after half a year or one year, or the follow-up treatment expenses are reviewed or recorded regularly, and the compensation payment voucher provided by the insurance record for the follow-up expenses can be reviewed. According to the needs of the disease, obviously beyond the needs of the disease, the audit fee for continuing medical treatment will not be compensated.
To sum up, China's basic medical insurance is divided into two categories: basic medical insurance for employees and basic medical insurance for residents. In terms of reimbursement of hospitalization expenses, basic medical insurance usually reimburses the inspection items that meet the medical insurance policy.
Legal basis:
Article 29 of People's Republic of China (PRC) Social Insurance Law
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.
Article 7
The administrative department of social insurance in the State Council is responsible for the national social insurance management, and other relevant departments in the State Council are responsible for the relevant social insurance work within their respective functions and duties.
The social insurance administrative department of the local people's government at or above the county level shall be responsible for the social insurance management within its administrative area, and other relevant departments of the local people's government at or above the county level shall be responsible for the relevant social insurance work within their respective functions and duties.