2. Whether commercial insurance is reimbursed depends on the scope of drug use specified by specific products. If the purchased commercial medical insurance does not restrict the use of social security drugs, it can be reimbursed. However, the products of some insurance companies will restrict the use of social security drugs, so they cannot be reported. Please study the insurance clauses carefully before buying insurance.
Medical insurance First of all, the difference between medical insurance drugs and non-medical insurance drugs, reimbursement deductible line is also different according to hospital level.
Generally, Class A drugs can enjoy full coverage, while Class C drugs need all out-of-pocket expenses, and Class B drugs report 80% and pay 20%.
A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you can deduct 2000 yuan first, which is the difference of deductible.
1. Special medical expenses include organ and tissue transplantation due to illness, organ and tissue purchase and use of anti-rejection drugs and immunomodulatory drugs beyond the scope of medical insurance reimbursement for Zhenjiang employees;
2. Work-related injuries and occupational diseases;
3. Female workers give birth;
4. Rogue fights;
5. Injuries caused by alcoholism;
6. Traffic accidents;
7. Others intentionally hurt;
8. Medical malpractice;
9. Beauty and health examination;
10, other expenses not paid by the social medical insurance fund.
1. The medical expenses incurred by the insured employees on business trips or visiting relatives in other places will only be reimbursed for emergency expenses in other places that meet the requirements of medical insurance, and all expenses incurred for hospitalization for non-emergency reasons will not be reimbursed.
2, the insured workers living in the field for more than 6 months, according to the nature of long-term living in the field of medical expenses.
3, long-term residents should provide proof by the unit, determine the secondary designated hospitals (should be designated medical institutions for local medical insurance), and timely handle the "Zhenjiang long-term residents medical expenses reimbursement card".
4. Employees who live in other places for a long time must adhere to the principle of economy and prescribe drugs in a limited amount according to regulations (the acute dosage is within 3 days, the chronic dosage is within 10 days, and the dosage of tuberculosis, hypertension and diabetes can be extended to 30 days). Those who exceed the above standards will not be reimbursed for medicine.
5, long-term resident workers referral, signed by the local designated hospitals, according to the principle of territoriality referral step by step. Referral hospital is a special hospital determined by medical insurance for employees in our city. The individual pays 65438+ 00% of the total expenses first, and then reimburses the expenses according to the medical insurance regulations; In other hospitals, individuals pay 20% of the total expenses first, and then reimburse medical expenses according to medical insurance regulations.