First, the coverage of the medical insurance policy for mental patients.
In China, the medical insurance policy aims to provide basic medical security for the public. As a member of society, mental patients should also be reimbursed for their medical expenses. Generally speaking, the expenses of psychiatric hospitalization can be included in the scope of medical insurance, but the specific reimbursement policy will vary according to the region, medical insurance type and hospital level.
Second, the reimbursement standard and proportion
For the medical insurance reimbursement of mental illness hospitalization, there is usually a certain deductible line and reimbursement ratio. The deductible refers to the part that the patient needs to pay, and the part that exceeds the deductible can be included in the medical insurance reimbursement. The reimbursement ratio refers to the medical expenses that meet the reimbursement conditions, and the proportion paid by the medical insurance fund will be different according to different medical insurance policies.
Third, reimbursement procedures and requirements
When applying for reimbursement of hospitalization medical insurance for mental illness, patients or their families need to prepare relevant supporting materials, such as hospitalization invoices, diagnosis certificates, medical insurance cards, etc. Then submit relevant materials and apply for reimbursement according to the regulations of the local medical insurance department. It should be noted that different medical insurance policies may have different reimbursement requirements and procedures, so it is best to know the local policies and regulations before applying.
Fourth, the handling of special circumstances.
For some special types of mental illness or hospitalization under special circumstances, the medical insurance policy may be adjusted or restricted. For example, some high-end or special treatments may not be reimbursed by medical insurance, or they need to meet certain conditions before they can be reimbursed. Therefore, in the face of these special circumstances, patients or their families need to carefully understand the medical insurance policy in order to make reasonable choices and arrangements.
To sum up:
Medical insurance reimbursement for mental illness hospitalization is guaranteed by medical insurance policy, but the specific reimbursement standards, proportions and procedures will be different according to different regions and different types of medical insurance. When applying for reimbursement, patients or their families need to understand and abide by local medical insurance policies and regulations, prepare relevant supporting materials, and apply according to prescribed procedures. At the same time, we also need to pay attention to the handling of special circumstances in order to make reasonable choices and arrangements when necessary.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 23 provides that:
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.
People's Republic of China (PRC) social insurance law
Article 28 provides that:
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.
People's Republic of China (PRC) social insurance law
Article 30 provides that:
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.