Dental medical insurance reimbursement project

The reimbursement items of oral medical insurance mainly include tooth filling, root canal treatment, tooth extraction and the treatment of periodontal disease, gingivitis and other dental diseases.

The scope of medical insurance dental reimbursement is:

Dental filling (including basic materials and treatment fees); Tooth extraction; The cost of treating periodontal disease, gingivitis and other dental diseases;

Medical beauty, such as tooth cleaning, dental inlay, porcelain teeth, dental implant, orthodontics, etc. , not within the scope of medical insurance reimbursement;

In addition, the self-funded proportion of oral medical insurance reimbursement is relatively high, such as chronic pulpitis, chronic periapical periodontitis and chronic periodontitis, and the self-funded proportion is about 55%.

You can swipe your medical insurance card when you see a dentist. The specific reasons are as follows:

1. Under normal circumstances, when you need to be hospitalized due to illness, you can go to your designated hospital with your medical insurance card and medical records, and settle with your medical insurance card. That is, some of them are paid by themselves, and some medical insurance centers and hospitals reimburse and settle accounts;

2 from designated hospitals to secondary or tertiary hospitals, medical insurance cards can be used for settlement;

3. The patient is critically ill and hospitalized in a non-designated hospital. He should go to the municipal medical insurance center for emergency rescue disease identification within 5 days. After being identified as an emergency rescue disease, he can use the medical insurance card for settlement in the rescue hospital;

4, transferred to other places for treatment, with the consent of the hospital and medical insurance center, the referral procedures. The expenses incurred in the field shall be settled by the individual at his own expense, and after the diagnosis and treatment, the community labor security workstation shall prepare the materials for reimbursement;

5. Special provisions have been made for the settlement of medical insurance cards for cancer, uremia, organ transplantation and hospitalization. The medical insurance card is still used when taking medicine out of the clinic, and the bills settled by individuals at their own expense are reimbursed by the community labor security workstation this year;

6. There are special circumstances that require phacoemulsification and intraocular lens implantation. Choosing a competent hospital is not necessarily your own designated hospital. No hospitalization, direct outpatient surgery, still using the medical insurance card, first settled at their own expense, and reimbursed by the community labor security workstation after diagnosis and treatment.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 24

The state establishes and improves the new rural cooperative medical system.

Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.

Article 25

The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; 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.

Article 28

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.