The medical insurance town health center will reimburse RMB 40 for examination fees. The examination fees and surgical fees for each visit are limited to RMB 50, and the prescription drug fee is limited to RMB 100. A visit to a secondary hospital is reimbursed at RMB 30, with a limit of RMB 50 for examination fees and surgical fees for each visit, and a limit of RMB 200 for prescription drugs. A visit to a tertiary hospital is reimbursed at RMB 20, with a limit of RMB 50 for examinations and surgeries per visit, and a RMB 200 limit for prescription drugs
The social medical insurance card (referred to as the medical insurance card or medical insurance card) is an individual medical insurance An account-specific card uses a personal ID card as an identification code and stores detailed information such as personal ID number, name, gender, and account fund allocation and consumption status.
Medical insurance cards are generally handled by local designated agent banks and are a type of bank’s multi-functional debit card. After the insured units pay the premiums, the local medical insurance department will entrust the bank to transfer the personal account funds to the insured employees' personal medical insurance cards at the end of the month.
Scope of use of medical insurance cards
1. Outpatient and emergency medical expenses
1. For current employees, after going to the hospital’s outpatient clinic or emergency room for medical treatment, medical expenses exceeding 1,800 yuan Only expenses can be reimbursed, and the reimbursement ratio is 50%.
2. Retirees under the age of 70 can be reimbursed for expenses exceeding 1,300 yuan, and the reimbursement ratio is 70%.
3. For retirees over 70 years old, the reimbursement rate for expenses exceeding 1,300 yuan is 80%.
2. Hospitalization expenses
The maximum payment amount of the basic medical insurance pooling fund (hospitalization expenses) in one year is currently 70,000 yuan.
1. The standard of hospitalization reimbursement is related to the level of the hospital where the insured person lives. For example, if the insured person lives in a third-level hospital, from the minimum payment standard to 30,000 yuan, the employee will pay 15, which is reimbursement. 85.
2. For expenses ranging from RMB 30,000 to RMB 40,000, the employee will pay RMB 10 and reimburse RMB 90.
3. For expenses exceeding 40,000 yuan up to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%.
4. The ratio of personal payment for retirees is 60% of that of active (the above-mentioned) employees, but anything below the minimum payment standard is paid by the individual.
3. Designated hospitals and designated retail pharmacies
Reimbursement scope of designated hospitals and designated retail pharmacies: insured persons must go to 4 designated medical institutions of their choice for personal medical treatment (excluding emergency cases) ), or only medical treatment at designated traditional Chinese medicine hospitals, specialists (including dental hospitals, obstetrics and gynecology hospitals, oncology hospitals, etc.) and 11 Class A medical institutions can be reimbursed
Legal basis
"China Article 28 of the Social Insurance Law of the People's Republic of China
Persons who comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be covered by the basic medical insurance in accordance with national regulations. Payment in the fund
Article 30 of the "Social Insurance Law of the People's Republic of China"
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(1) Should be paid from the work-related injury insurance fund;
(2) Should be borne by a third party;
(3) Should be paid by the public health department ;
(4) Seeking medical treatment abroad. Medical expenses shall be borne by a third party in accordance with the law. If the third party fails to pay or the third party cannot be identified, the basic medical insurance fund shall pay first. After the basic medical insurance fund has paid in advance, it has the right to recover compensation from the third party.