If students buy medical insurance, they can also enjoy medical insurance reimbursement when seeking medical treatment, and the specific reimbursement ratio is determined according to the actual situation.
1. What is the reimbursement rate of medical insurance for students living in different places?
(a) in accordance with the provisions of the outpatient medical expenses, according to the following proportion of reimbursement, the rest of the individual pays:
1, if the medical expenses are insufficient 1000 yuan, 35% will be reimbursed;
2, medical expenses in 1000 yuan (including 1000 yuan) above, less than 5000 yuan, 45% reimbursement;
3, medical expenses in more than 5000 yuan (including 5000 yuan), less than 10000 yuan, 55% reimbursement;
4, medical expenses in 1 ten thousand yuan (including 1 ten thousand yuan) above, reimbursement of 65%.
(two) in accordance with the provisions of the medical expenses incurred in hospitalization, according to the following proportion to be reimbursed, the rest of the individual pays, and the medical expenses of multiple hospitalizations during the year are calculated:
1, medical expenses 10000 yuan, medical treatment in tertiary, secondary and primary medical institutions, with reimbursement rates of 55%, 65% and 75% respectively;
2. The medical expenses are above 10000 yuan (including 10000 yuan) and within 20000 yuan, and the reimbursement rates in tertiary, secondary and primary medical institutions are 60%, 70% and 80% respectively;
3, medical expenses in more than 20000 yuan (including 20000 yuan), in the tertiary, secondary and primary medical institutions, the reimbursement rate is 65%, 75% and 85% respectively.
2. What does the scope of medical insurance reimbursement cover?
According to the regulations, the basic medical insurance for five types of diagnosis and treatment projects will not be paid.
The first category is service items: some medical service fees, out-of-hospital consultation fees, medical record production fees, etc. Special medical services such as visiting fees, expedited fees for examination and treatment, additional fees for name-calling surgery, additional fees for name-calling surgery, high-quality and good-price fees, and self-invited special care.
The second category is non-disease treatment items: see the following analysis for details.
The third category is diagnosis and treatment equipment and medical useful materials: inspection and treatment projects carried out by using large-scale medical equipment such as positron emission tomography (PET), electron beam CT and ophthalmic excimer laser therapeutic apparatus. Glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation appliances. All kinds of self-use health care, massage, examination and treatment equipment. Disposable medical materials that are not charged separately as stipulated by the provincial price department.
The fourth category is treatment project category: organ source or tissue source of various organ or tissue transplants; Transplantation of organs or tissues other than kidneys, heart valves, corneas, skin, blood vessels, bones and bone marrow; Orthopedic surgery for myopia; Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
The fifth category is other categories: all kinds of scientific research and clinical verification diagnosis and treatment projects.
In addition, the expenses not paid by the basic medical insurance also include: transportation expenses and emergency expenses; Infant incubator fee, food incubator fee, nursing fee, washing fee and outpatient decocting fee; Special living expenses such as meals. Patients should pay for the above items when seeking medical treatment.
Among them, non-disease treatment projects include these:
1, various cosmetic plastic surgery projects: such as acne, scar cosmetic, laser cosmetic, cosmetic tooth washing, hair transplant, etc.
2. Orthopedic treatment items: stuttering, dentition disorder, denture restoration (including post crown, crown fitting, denture installation), dental implantation, nasal snoring surgery (except respiratory distress), flat feet and other items (except congenital torticollis, cleft lip and palate, sequelae of polio).
3. Various bodybuilding treatment items: such as losing weight, gaining weight and increasing height.
4. Various physical examination items: such as employee physical examination and disease investigation.
5. Various preventive health care and diagnosis projects: such as various vaccines, fitness massage, etc.
6. Various medical consultation and health prediction diagnosis and treatment items: such as various disease consultation fees (except psychological consultation conducted by secondary and tertiary mental health prevention and control institutions), including pulse meter, microcirculation tester, meridian diagnostic instrument (including computer diagnostic instrument of traditional Chinese medicine) and vital information diagnostic instrument.
7. Various medical appraisal items: such as labor ability appraisal (diagnosis and appraisal of workers' labor, work-related injuries and occupational diseases), judicial appraisal of mental patients, medical accident appraisal, and various inspection expenses.
3. Is there an upper limit for medical insurance reimbursement?
Medical reimbursement is limited. No matter what kind of people, the maximum payment for outpatient and emergency medical expenses is 20 thousand yuan per year. However, different groups of people have different reimbursement rates. The maximum payment limit of the basic medical insurance pooling fund for hospitalization 1 year is 70,000 yuan.
Generally speaking, the economic development in different regions is different, so the reimbursement ratio is different. The following is an explanation of the proportion of employees' medical insurance in Beijing.
After receiving medical insurance, if they are on-the-job employees, the medical expenses above 1800 yuan can only be reimbursed, and the reimbursement rate is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 700 yuan can reimburse 50%, that is, 350 yuan.
If it is hospitalization expenses, the minimum payment for employees and retirees is 1300 yuan when the basic medical insurance is used for the first time within one year in 2009. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan.
The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals.
There is an upper limit on the amount of medical insurance reimbursement, with a maximum of 20,000 yuan per year for outpatient service and 70,000 yuan for hospitalization.
According to the law, it can be known that the medical expenses incurred by students in different places who choose medical insurance designated medical institutions in their places of residence for medical treatment are paid in full by individuals first, and then reimbursed with relevant materials after medical treatment.
Legal objectivity:
Article 28 of the 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.