1, only the treatment expenses such as dental treatment expenses and operation expenses are reimbursed.

2. If the patient is admitted to the hospital due to illness and meets the hospitalization standard, other expenses can be settled according to the provisions of medical insurance except that the denture expenses cannot be paid by the medical insurance pooling fund.

3. Dental treatment expenses such as tooth extraction and tooth filling are paid by medical insurance. When going to the dental clinic of the hospital, the reimbursement rate of medical insurance is 65438 yuan+more than 0800 yuan, 50%.

Dental implants and medical beauty are not covered by reimbursement.

Whether the dentist can reimburse depends mainly on what he is looking at. Because not all dental projects are in the basic medical insurance coverage. Usually, dental treatment items are covered by medical insurance reimbursement, while dental beauty items are not covered by medical insurance reimbursement.

Within the scope of medical insurance reimbursement, there are mainly tooth filling (including basic materials and treatment fees) and tooth extraction, as well as the treatment of periodontal disease, gingivitis and other dental diseases; Orthodontics, dental implants, tooth washing, porcelain teeth, dental implants and so on are not covered by medical insurance reimbursement.

The new medical insurance regulations:

First, from 2023, there will be no capping line for the treatment of employees in outpatient clinics.

At present, the maximum payment limit of outpatient (emergency) consultation expenses incurred by insured employees in this city within one year is 20,000 yuan, and the part exceeding 20,000 yuan shall be borne by individuals.

Since June 65438+ 10/day, 2023, the maximum payment limit for medical insurance outpatient service for employees is no longer set, and the reimbursement ratio of less than 20,000 yuan remains unchanged; Employees with more than 20,000 yuan will be reimbursed 60%, and retirees will be reimbursed 80% (including unified supplementary medical insurance for retirees). There is no upper limit.

It is estimated that it will benefit 1.7 million insured persons every year and reduce the burden of insured persons by about 1 100 million yuan.

Second, from September 1, personal accounts can't be withdrawn freely, and they can be used directionally.

According to the requirements of basic medical insurance fund management, individual account funds should be earmarked.

From September 1 2022, the personal account funds will be managed by bookkeeping, and the insured personnel can't withdraw them freely, so as to realize directional use, which is mainly used to pay the medical expenses incurred by the insured employees themselves in designated medical institutions or retail pharmacies.

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

Third, improve the method of transferring individual accounts, and all unit contributions will be transferred to the overall fund.

From September 1 2022, all the basic medical insurance premiums paid by employers will be included in the overall fund, and all the basic medical insurance premiums paid by employees will be included in personal accounts, and the payment ratio will remain unchanged; Retirees' personal accounts are allocated by the overall fund according to the quota, and the current standards are still implemented. Under the age of 70 (excluding), it will be allocated according to 100 yuan/month, and over the age of 70, it will be allocated according to 1 10 yuan/month.

Iv. 65438+February 1 Personal account can be family * * *

Since June 5438+February 1 day, 2022, spouses, parents and children who participate in the basic medical insurance in this Municipality are allowed to use the funds of family members' personal accounts to pay the relevant expenses incurred by themselves and the recipients according to the provisions of the scope of use of personal accounts. They can use personal accounts to participate in the payment of basic medical insurance and long-term care insurance for urban and rural residents in this Municipality and purchase supplementary medical care in this Municipality.

Fifth, improve the level of serious illness insurance. In 2022, the deductible for serious illness of employees will be reduced to 30,404 yuan.

In order to further reduce the burden of medical expenses for employees with serious illness, starting from 2022, the threshold for employee serious illness insurance will be reduced from 39,525 yuan to 30,404 yuan.

After the insured enjoys the treatment of basic medical insurance for urban workers, the accumulated out-of-pocket medical expenses of outpatients and inpatients exceed the Qifubiaozhun within one year, which shall be reimbursed by the medical insurance for serious illness of urban workers.

Qifubiaozhun is more than 50,000 yuan (that is, 30,404 yuan to 80,404 yuan), 60%, and 50,000 yuan (that is, 80,404 yuan), 70%, with no upper limit.

It is estimated that it will benefit 35,000 insured persons every year and reduce the burden of insured persons by 654.38+0.2 billion yuan.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

Article 28

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.