1, social security payment
Social security has been paid off, and medical insurance has also been paid off. Naturally, medical insurance cards cannot be reimbursed.
Solution: pay back social security. It should be noted that under normal circumstances, individuals cannot pay social security for urban workers, and only units can pay. If there is no unit, you can try to pay social security for flexible employees.
2. The social security payment time is not enough.
Under normal circumstances, employees can enjoy medical insurance benefits by paying social security for three months in a row;
Secondly, the medical insurance for urban and rural residents and the new rural cooperative medical system can only enjoy treatment within the insured year. For example, on 20 18, the insured did not participate in the insurance, but paid the medical insurance fee on 20 19, so the insured can only enjoy the medical insurance benefits of 20 19.
Solution: urban workers' medical insurance will continue to be paid, and then urban and rural residents' medical insurance and the new rural cooperative medical system will be provided.
The social security card has been degaussed.
Degaussing social security cards is quite common, and all friends in Cai Jun have encountered it.
Solution: consult the local social security agency, magnetize or change the card.
4. Drugs are not covered by medical insurance reimbursement.
Medical insurance has the scope of reimbursement, and not all medical services and medicines can be reimbursed.
Solution: It is best to consult a doctor before prescribing medicine to confirm whether it can be reimbursed.
5. It should be regarded as a work-related injury.
Industrial injury refers to work-related diseases. Work-related injury insurance is generally included in the social security paid by the unit to solve work-related injuries, so such medical expenses are not covered by medical insurance.
Not all cases of medical insurance can be reimbursed. If these five situations are not eligible for medical insurance reimbursement,
1, in the treatment waiting period or social security payment period.
After the employee's social security is broken off, the balance of the medical insurance personal account is not cleared, and the balance can continue to be used until it is used up; Just because medical insurance is pay-as-you-go, it can't be reimbursed as a whole next month.
When the insured person successfully pays social security again, some cities can use it the next month, and some cities need to pay it for 6 months, depending on the actual situation.
2. Did not seek medical treatment in the designated hospital.
It can only be reimbursed at designated medical insurance hospitals and pharmacies. Some cities should choose fixed designated medical insurance hospitals in advance. If you forget your designated medical insurance hospital, you must check it out in advance.
3. Medical expenses are not covered by medical insurance reimbursement.
Whether outpatient or inpatient, there is a minimum amount of medical insurance reimbursement, and the medical expenses consumed in designated hospitals must reach the deductible line to be reimbursed. As for the specific deductible, urban workers are different from urban and rural residents, and employees and retirees are different. The standard of deductible varies from place to place, depending on local conditions.
4, special medical care:
The scope of medical insurance reimbursement is generally in some routine items such as registration fee, consultation fee and operation fee. Medical expenses arising from plastic surgery and weight loss cannot be reimbursed by medical insurance.
5. Drugs are not covered by medical insurance reimbursement.
legal ground
Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations.