First, the role of social security card: cardholders can use this card to seek medical treatment and settle personal accounts for medical insurance; You can handle endowment insurance affairs with your card; You can apply to the relevant departments for job registration and unemployment registration, unemployment insurance and employment training; You can apply for labor ability appraisal with your card and enjoy work-related injury insurance benefits.
Second, hospitalization reimbursement: 1, hospitalization qifubiaozhun: level III includes hospitals above level III: 700 yuan has multiple hospitalization qifubiaozhun for 500 yuan, 400 yuan and 300 yuan within one year. 2. Secondary hospitals include secondary specialized hospitals: 600 yuan was hospitalized several times in one year, followed by 400 yuan, 300 yuan and 200 yuan.
3. The first level includes the following hospitals: 500 yuan was hospitalized several times in one year, with the starting salary of 300 yuan and 200 yuan, 100 yuan. Extended data:
Basic information such as the cardholder's name, gender and citizenship number are recorded on the card face and inside the card. The card identifies the cardholder's personal identity (employment, unemployment, retirement, etc.). ), and can record the cardholder's social insurance payment, pension insurance personal account information, medical insurance personal account information, professional qualifications and skills, working experience, work-related injuries and occupational diseases.
Social security card is the electronic certificate for workers to work in the field of labor security. Cardholders can use their cards to seek medical treatment and settle medical insurance personal accounts; You can handle endowment insurance affairs with your card; You can apply to the relevant departments for job registration and unemployment registration, unemployment insurance and employment training; You can apply for labor ability appraisal with your card and enjoy work-related injury insurance benefits.
In addition, the social security card is the key for workers to open the door to the contact system. With this key, cardholders can query information online and handle related labor and social security affairs online in the future. References:
Baidu Encyclopedia: Social Security Card of the People's Republic of China.
I got my social security card,
Take the social security card issued by the company to the hospital for reimbursement. The specific process is as follows: 1. First, the insured person goes to see a doctor and goes to the registration office with a social security card.
2. The insured person goes to the clinic with the registration form, and the doctor will prescribe the payment after reading it for the insured person. 3. After the insured person takes the prescription to the hospital settlement window for pricing, he can directly brush the social security card to pay the medical expenses within the scope of medical insurance fund payment.
4. If some drugs in the prescription are not covered by the medical insurance fund, the insured needs to pay cash. According to Article 30 of the Social Insurance Law, the following medical expenses are not included in the payment scope of the basic medical insurance fund: (1) They should be paid from the industrial injury insurance fund.
According to Article 64 of the Social Insurance Law, the medical expenses that should be paid by the industrial injury insurance fund cannot be included in the scope of payment by the basic medical insurance fund. (2) borne by a third party.
The medical expenses incurred by the insured due to personal injury caused by a third party shall be borne by the third party. (3) It should be borne by public health.
According to the project to provide basic public health services for urban and rural residents free of charge, the standard of funds is approved according to the comprehensive cost of unit services, and the required funds are arranged by the budget of * * * *. (4) Go abroad for medical treatment.
The medical expenses for overseas medical treatment are not included in the payment scope of the basic medical insurance fund.
How to reimburse the social security card issued by the unit to the hospital?
First of all, when the insured person goes to see a doctor, he will write a prescription and pay the fee after taking the social security person to see a doctor.
The insured person goes to the doctor with the registration form, and the doctor registers the insurance card at the registration office. After the insured person takes the prescription to the hospital settlement window for pricing, he can directly swipe the social security card to pay the medical expenses within the scope of the medical insurance fund.
If some drugs in the prescription are not covered by the medical insurance fund, the insured person needs to pay cash. Extended data:
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 70 years old, 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. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan.
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. 1 year The maximum payment limit of the basic medical insurance pooling fund (hospitalization expenses) is 70,000 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.
The medical treatment items that employees' basic medical insurance does not pay are mainly those that are clinically unnecessary and have uncertain curative effects, and those that need special medical services, including services such as registration fees, non-disease treatment items such as beauty, therapeutic equipment and medical materials hearing AIDS, magnetic therapy and other types of infertility treatment. According to the scope of national basic medical insurance diagnosis and treatment projects, the details are as follows: (1) Service projects.
(1) Registration fee, out-of-hospital consultation fee, medical record fee, etc. (2) Special medical services, such as visiting fees, expedited fees for examination and treatment, additional fees for roll-call surgery, high-quality and low-price fees, and self-invited intensive care. (2) Non-disease treatment projects.
(1) all kinds of beauty and bodybuilding, as well as non-functional plastic surgery and orthopedic surgery; (2) various weight loss, weight gain and height increase projects; (3) various health checks; (4) all kinds of preventive health care and diagnosis projects; (5) all kinds of medical consultation and medical appraisal. (3) Diagnostic equipment and medical materials.
(1) Examination and treatment items of large medical equipment such as positron emission tomography (PET), electron beam cT and ophthalmic excimer laser therapeutic instrument; (2) glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation devices; (3) all kinds of self-use health care, inspection and treatment equipment; (4) The provincial price department stipulates that one-time medical treatment cannot be charged separately. (4) Treatment items.
(1) The organ source or tissue source of various organ or tissue transplants; (2) Transplantation of organs or tissues other than kidneys, heart valves, corneal skin, blood vessels, bones and bone marrow; (3) Orthopedic surgery for myopia; (4) Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects. (5) others.
(1) various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects; (2) all kinds of scientific research and clinical verification of diagnosis and treatment projects. References:
Proportion of medical insurance reimbursement.
How can I reimburse myself if I have a social security card and see a doctor in an outpatient clinic?
Just show your social security card directly.
When seeing a doctor in a designated hospital, you can show your social security card to prove your insured identity and registration. Individuals can be directly reimbursed by social security and hospitals, without having to pay first and then reimburse. Only when the account is settled can the balance of social security card or cash be used to pay the self-paid part. Detailed reimbursement regulations: the scope of reimbursement: the general outpatient and emergency expenses incurred by the insured in the designated medical insurance hospital or specialized hospital, Chinese medicine hospital and 3A hospital selected by the individual.
Outpatient deductible line: the total emergency expenses of general outpatient service exceed 1800 yuan in a natural year. Reimbursement ratio: 70% for the hospital, 90% for the community, and 20,000 yuan for the capping line.
Extended data:
The Social Security Card of the People's Republic of China is an integrated circuit (ic) card, which is uniformly planned by Ministry of Human Resources and Social Security and issued to the public by local human resources and social security departments, and used in various business fields of human resources and social security. Social security cards have a wide range of functions.
Cardholders can not only use the card for real-time settlement of medical insurance personal accounts, but also handle endowment insurance affairs; Go through the formalities of job registration and unemployment registration; Apply for unemployment insurance; Apply for employment training; Apply for labor ability appraisal and enjoy work-related injury insurance benefits; Handling labor and social security affairs online. The social security card adopts the national unified standard, and the social security number adopts the citizenship number in accordance with the relevant provisions of the Social Insurance Law.
References:
Baidu encyclopedia-social security card.
How to reimburse rural social security cards?
1. Take the initiative to show your social security card when registering. The registration fee is two yuan from the medical insurance fund, and the rest is paid by yourself.
2. When presenting the social security card and the medical record manual, you should take the initiative to show it to the doctor and ensure the continuous use of the medical record manual. 3. Show your social security card at the time of settlement. The reimbursement part is paid in advance by the hospital, and you only need to pay the part that is not reimbursed. Each unit has different insurance methods. One insurance method is to deduct more money from your salary. If there is no money requirement when going to see a doctor, 90% of all medical expenses can be reimbursed in medical insurance. There is another way, only a limited amount can be reimbursed, and the rest of the expenses are self-care.
Farmers' social security card can enjoy the service in the future: 1. As a hospital card, farmers can directly seek medical treatment and settle expenses in hospitals all over the country with the social security card. 2, pharmacy credit card use: in life, it is inevitable that there will be headaches and brain fever. Some diseases, such as colds, can take the social security card to the pharmacy to brush medicine, which is convenient and saves money.
3. Used as a bank card: The social security card can be used as a bank debit card with embedded financial functions, which means that the social security card can do everything that a bank card can do. 4. Fitness Consumer Credit Card: A pilot "Health Insurance Card Fitness" has been launched in many parts of the country, which should be fully promoted in the later period. When you go to the gym, you can also use the money in your social security card to offset your consumption.
5. Citizen card: The social security card can also be used as a citizen card, such as paying water and electricity bills, swiping a bus card, and electronic wallet functions. 6. Subsidy card: whether it is agricultural subsidies or poverty alleviation subsidies, subsistence allowances, pensions, etc. Will directly enter the farmers' social security card, without worrying about the problem in the middle.
How much can social security card be reimbursed for hospitalization?
The reimbursement rate of social security card hospitalization is: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total hospitalization reimbursement of 300,000 yuan.
Inpatient deductible line: The standard of the first hospitalization deductible line in a natural year is 1.300 yuan, with 650 yuan as the unit each time. Social security card hospitalization reimbursement scope: hospitalization expenses incurred by the insured in designated medical insurance hospitals or specialized hospitals, traditional Chinese medicine hospitals and 3A hospitals selected by individuals.
Social security card hospitalization reimbursement process: please use the medical insurance manual for medical treatment. If the unit pays in full, the individual can go through the hospitalization formalities only by paying part of the advance payment for hospitalization, and the medical expenses incurred should meet the scope of medical insurance. When leaving the hospital, the hospital and the individual will settle the expenses themselves, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center. Extended data:
Outpatient reimbursement: 1, scope: general outpatient and emergency expenses incurred by the insured in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by the insured.
2. Outpatient deductible line: the total emergency expenses of general outpatient service exceed 1.800 yuan in a natural year. 3. Reimbursement ratio: 70% for the hospital, 90% for the community, and the top line: 20,000 yuan.