First, the scope of medical insurance reimbursement is as follows:
1, drugs allowed to be reimbursed within the reimbursement scope of basic medical insurance;
2, within the scope of the basic medical insurance reimbursement allows reimbursement of diagnosis and treatment projects;
3 expenses incurred by medical service facilities that are allowed to be reimbursed within the scope of reimbursement of basic medical insurance. Reimbursement expenses are mainly paid by the overall fund, and individuals have to pay a corresponding part.
Two, medical insurance reimbursement methods are as follows:
1. If you are hospitalized in a designated medical institution, you will bring your medical insurance card and ID card to the settlement window of the designated hospital for direct settlement and accounting when you leave the hospital;
2. If you seek medical treatment in a different place, call the social security bureau where the insured person is located within three days of admission, register for the record, and return to the local social security bureau for reimbursement within one month.
Three, medical insurance reimbursement conditions are as follows:
1, the newly insured and re-insured employees who have stopped paying 1 year or more shall participate in the basic medical insurance according to law and pay for 6 months continuously, and enjoy the basic medical insurance benefits according to regulations;
2, continuous payment of less than 6 months, do not enjoy the basic medical insurance benefits;
3. If the payment is interrupted for less than one year, you will enjoy the treatment according to the regulations after re-insurance payment;
4, the interruption of payment personnel do not enjoy the basic medical insurance benefits during the interruption of payment.
To sum up, medical insurance can be reimbursed. The proportion of reimbursement depends on the diseases to be reimbursed.
legal ground
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.