How many beds can medical insurance reimburse?

Generally living in a double ward or a single ward, you have to bear the expenses beyond the scope of medical insurance reimbursement. For example, the hospital bed fee is reported to 40 yuan every day, and the double ward is reported to 70 yuan every day, so the extra beds will be 30 yuan.

Specifically:

Social security can reimburse bed fees. However, employees who seek medical treatment in non-designated medical institutions or do not meet the basic medical insurance payment standards during medical treatment will not be reimbursed.

For example, refer to the second point of Article 2 of the Settlement Measures for Urban Workers' Basic Medical Insurance in Shanghai, and settle the medical expenses for outpatient serious illness and family beds.

Settlement of medical expenses for outpatient serious illness and family sickbed

1, the medical expenses of serious illness and family sickbed in outpatient department of workers shall be paid by the basic medical insurance pooling fund and additional funds, and shall be accounted by the designated medical institutions; The expenses paid by the individual medical account are deducted from the balance funds of the individual medical account over the years. Bookkeeping and medical expenses deducted from personal medical accounts shall be settled by designated medical institutions to the local district and county medical insurance offices; The rest of the medical expenses shall be collected from employees by designated medical institutions.

2. Family sickbed medical treatment. If the bed has been built for less than 6 months, the designated medical institution shall apply for medical expenses settlement when withdrawing the bed; If the bed has been built for more than 6 months, the designated medical institution shall apply for the settlement of medical expenses every 6 months or when the bed is dismantled.

3, workers for family sickbed medical treatment, designated medical institutions can charge prepaid fees according to their illness. The specific standards shall be formulated separately by the Municipal Health Bureau and the Municipal Medical Insurance Bureau.

Extended data:

China medical insurance reimbursement regulations:

According to the basic requirements of the payment of basic medical insurance benefits in China, the insured person who goes to the medical insurance institution to reimburse the medical expenses incurred by himself for medical treatment generally meets the following conditions:

(1) The insured must go to the designated medical institution of basic medical insurance or to the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital.

(2) The medical expenses incurred by the insured in the process of medical treatment must conform to the basic medical insurance drug list, diagnosis and treatment items, the standard scope of medical service facilities and payment standards, and be paid by the basic medical insurance fund according to regulations.

(III) Among the medical expenses that the insured meets the scope of payment of basic medical insurance, the part that is higher than the Qifubiaozhun of the social medical co-ordination fund and lower than the maximum payment limit shall be paid by the social medical co-ordination fund in a unified proportion.

Reimbursement ratio

1, outpatient and emergency medical expenses: the medical expenses that meet the requirements of basic medical insurance in the year (11October1February 31February) exceeded 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.

4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing.

Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.

5. Hospitalization.

After paying medical insurance for 20 years, you can enjoy medical insurance reimbursement after retirement.

The proportion of medical insurance reimbursement varies from place to place. Please refer to local policies for details.