[ad_1]
Clause 3 of Article 22 of the 2008 Health Insurance Law (amended and supplemented in 2014) stipulates:
3. In cases where the holder of a health insurance card does not seek medical treatment at the wrong level, the health insurance fund will pay the benefit rate specified in Clause 1 of this Article in accordance with the following rates, except in prescribed cases. in Clause 5 of this Article:
a) In central hospitals, 40% of the costs of hospital treatment;
b) In the provincial hospital, 60% of the costs of hospital treatment from the effective date of this Law until December 31, 2020; 100% of the cost of hospital treatment as of January 1, 2021 nationwide;
c) In district hospitals, 70% of the expenses for medical examinations and treatments from the effective date of this Law until December 31, 2015; 100% of the medical examination and treatment expenses as of January 1, 2016.
So:
** Starting in 2021, will health insurance participants get 100% of their medical examination and treatment expenses from the health insurance fund?
According to the above provisions, from 2021, the holder of a health insurance card, when going to a hospital in a provincial hospital, will be paid by the health insurance fund at the rate specified in Clause 1, Article 22 of the Health Insurance Law. 2008 (the entitlement rate when passing to the correct level of examination) based on the 100% share of hospital treatment costs nationwide (currently 60%), specifically as follows:
– In the event that the health card enjoys 80% of the cost of the medical examination and treatment:
+ Currently, going to provincial health insurance is paid at a rate of 60% to 80% of the cost of hospital treatment (that is, 48% of the cost of hospital treatment).
+ As of January 1, 2021, provincial health insurance is paid at a rate of 100% of 80% of the costs of hospital treatment (that is, 80% of the costs of hospital treatment).
– For a health insurance card that enjoys 95% of health insurance costs:
+ Currently, going to provincial health insurance is paid at a rate of 60% to 95% of the cost of hospital treatment (that is, 57% of the cost of hospital treatment).
+ As of January 1, 2021, going to provincial health insurance is paid at a rate of 100% to 80% of the cost of hospital treatment (that is, 95% of the cost of hospital treatment).
– In the event that the health card enjoys 100% of the cost of health insurance:
+ Currently, going to provincial health insurance is paid at a rate of 60% of 100% of the cost of hospital treatment (that is, 60% of the cost of hospital treatment).
+ From 1-1-2021, provincial level medical examination and treatment are paid at a rate of 100% to 80% of the cost of hospital treatment (ie 100% of the cost of hospital treatment).
Thus: Starting in 2021, when the holder of the health card goes to the provincial hospital for hospital treatment, if he has hospital treatment, the health insurance fund will pay 100% of the cost of the hospital treatment according to the level of address of the health card.
** Are inpatient or outpatient treatments covered by health insurance?
In accordance with Clause 3, Article 22 of the Health Insurance Law of 2008 (amended and supplemented in 2014), this regime only applies to hospital treatment; It does not apply for outpatient treatment.
** In any case, does the holder of the medical insurance card go for a medical examination and treatment is entitled to medical insurance in any case?
Pursuant to Article 23 of the Health Insurance Law 2008 and Clause 16 of Article 1 of the Health Insurance Law as amended in 2014, holders of health insurance cards will not be entitled to health insurance in the following cases:
– Medical examination and treatment expenses (in the case of having the right to medical insurance covered by the state budget.
– Nursing and nursing in nursing and nursing centers.
– Physical exam.
– Pregnancy tests and diagnosis are not for treatment purposes.
– Use of assisted reproductive technology, family planning services, abortion, abortion, except in cases of suspension of pregnancy due to pathological causes of the fetus or the pregnant woman.
– Use beauty services.
– Treatment of strabismus, myopia and refractive error of the eye, except for children under 6 years of age.
– Use of alternative medical supplies including prosthetics, artificial eyes, dentures, glasses, hearing aids, mobility aids in medical examinations and treatments and functional rehabilitation.
– Recognition and medical treatment, functional rehabilitation in case of disasters.
People perform medical examinations and treatment procedures under medical insurance.
– Examination and treatment of drug addictions, alcoholism or other addictive substances.
– Medical examination, forensic assessment, mental forensic assessment.
– Participate in clinical trials, scientific research.
Thus: The holder of a health card goes when they go to the hospital at the provincial level, if they fall into any of the above cases, they are not entitled to medical insurance.
[ad_2]
