1. Outpatient and emergency reimbursement: the reimbursable dental treatment fees and medical beauty items generated by Shanghai Stomatological Hospital, Hospital Stomatology Department, Stomatological Clinic and other institutions are not included in the scope of medical insurance.
2. Hospitalization reimbursement: Necessary dental treatment expenses incurred due to hospitalization, including tooth extraction, complex root canal treatment, tooth cleaning, periodontal disease treatment, gum plastic surgery, etc., can be included in the scope of medical insurance, which is in line with the medical insurance reimbursement policy.
Dental medical insurance reimbursement materials:
1, medical insurance card: use a valid medical insurance card for settlement in hospitals or outpatient clinics;
2. Outpatient medical records: Outpatient medical records record the dentist's condition, treatment plan, expenses and other information, and need originals and copies;
3. Medical expenses: medical expenses for going to the dentist should be provided, including details of medical expenses, medicine expenses, examination fees, etc. The original and photocopy are required;
4. List of dental treatment items: If the dentist needs dental treatment, it is required to provide a list of dental treatment items, including treatment items, treatment costs and other information, and the original and photocopy are required;
5. Other relevant materials: such as diagnosis certificate, treatment plan, doctor's prescription, etc.
Conditions for reimbursement of medical insurance in different places:
1, participation status: reimbursement for medical insurance in different places is only applicable to those who participate in medical insurance systems such as urban workers' basic medical insurance, urban and rural residents' basic medical insurance and new rural cooperative medical care;
2. Payment record: when applying for reimbursement in different places, the applicant must have paid the medical insurance fee and meet the requirements of payment time and standard;
3. Reimbursement scope: policies such as reimbursement scope and reimbursement ratio of medical insurance in different places shall be subject to the relevant policies and regulations of the insured place. It should be noted that medical insurance reimbursement policies may be different in different regions, and applicants need to handle them according to local policies and regulations;
4. Hospital selection: When seeking medical treatment in different places, the applicant must choose a designated medical institution for medical insurance, otherwise he will not be able to enjoy medical insurance reimbursement;
5. Reimbursement application materials: Applicants need to prepare complete reimbursement application materials, including medical bills, expense lists, medical treatment certificates in different places, and reimbursement application forms.
To sum up, the proportion and standard of medical insurance reimbursement vary according to different regions and policies, and the specific situation needs to be operated according to local regulations and requirements.
Legal basis:
Article 23 of People's Republic of China (PRC) Social Insurance Law
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.