If the patient is admitted to the hospital due to illness and meets the hospitalization standard (except that the denture expenses cannot be paid by the medical insurance pooling fund), other expenses can be settled according to the medical insurance regulations. At present, according to the national medical reimbursement regulations, dental treatment expenses and surgical expenses are mainly included in the scope of medical insurance, such as tooth filling (basic materials and treatment expenses), root canal treatment, tooth extraction, tooth filling, periodontal treatment, gums and so on.
The cost of dental diseases such as inflammation. Tooth beauty mainly includes tooth inlay, porcelain teeth, tooth cleaning, orthodontics, tooth implantation and so on. These price departments are designated as special service fees and cannot be reimbursed by medical insurance.
As long as it meets the national reimbursement requirements, it can be reimbursed. But the reimbursement rate is different. Generally, secondary hospitals reimburse 40%, tertiary hospitals reimburse 30%, and urban workers incur medical expenses below 654.38+10,000 yuan in a settlement year. The threshold of tertiary hospitals is 659 yuan, and the upper limit of reimbursement ratio is 2000 yuan. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%. There is no threshold for first-class hospitals. The reimbursement of strabismus surgery expenses is related to medical insurance category, local medical insurance policy and hospital level. These expenses include preoperative routine examination, nursing and medicine expenses, disposable medical materials expenses, namely intraocular lens expenses and surgery expenses.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; 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.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.