Hospitalization caused by general emergency can be reimbursed at their own expense. I can bring my ID card, medical insurance card, hospital emergency medical records, inspection reports, invoices, expense lists and other related materials to the medical insurance agency for reimbursement.
Generally divided into the following situations,
1. Individuals who enjoy basic medical reimbursement need not pay the settlement fee for each hospitalization. For example, 50,000 yuan, the individual is responsible for 1 10,000 yuan, then the individual only pays 1 10,000 yuan, and the remaining 40,000 yuan is settled by the hospital and social security center. However, there are still many personal benefits, and the large mutual assistance of medical insurance can also be reimbursed. In other words, if the personal conceit exceeds 1300 every time (after the second time, the pay line becomes 650), you can also take the bill to the company, and the company will declare it again. The part that exceeds 1300/650 this time will be reimbursed according to the proportion of segments.
2. There is a deductible line for hospitalization reimbursement (the deductible line standard is generally 10% of the average annual salary of employees in the city last year), which means that you need to pay the deductible line yourself, and the part that exceeds the deductible line can be reimbursed according to local medical insurance regulations. The reimbursement rate varies from place to place, and different projects in different hospitals are different, about 80%. You can go to the local labor and social security online for details.
Legal basis:
Notice of the Ministry of Labor and Social Security, the Ministry of Health and state administration of traditional chinese medicine Municipality on Printing and Distributing the Interim Measures for the Administration of Designated Medical Institutions of Basic Medical Insurance for Urban Employees
first
In order to strengthen and standardize the management of designated medical institutions for urban workers' basic medical insurance, these measures are formulated in accordance with the Decision of the State Council on Establishing the Basic Medical Insurance System for Urban Workers (Guo Fa [1998] No.44).
Article 2 The term "designated medical institutions" as mentioned in these Measures refers to the medical institutions that provide medical services for the insured persons of the basic medical insurance for urban workers, which have been audited by the administrative department of labor and social security in the overall planning area and determined by the social insurance agency.
Article 3 The principles for examining and determining designated medical institutions are as follows: it is convenient for insured persons to seek medical treatment and convenient for management; Give consideration to specialty and comprehensive, Chinese and western medicine, and pay attention to the role of community health service institutions; Promote the optimal allocation of medical and health resources, improve the utilization efficiency of medical and health resources, reasonably control the cost of medical services, and improve the quality of medical services.
Article 4 The following categories of medical institutions approved by the administrative department of health and obtained the Practice License for Medical Institutions, as well as military medical institutions approved by the competent military department and qualified for foreign service, may apply for designated qualifications:
(1) General hospitals, traditional Chinese medicine hospitals, integrated traditional Chinese and western medicine hospitals, ethnic medicine hospitals and specialized hospitals;
(2) Central hospitals, township (town) hospitals, street hospitals and maternal and child health centers (institutes);
(3) Comprehensive outpatient department, specialist outpatient department, traditional Chinese medicine outpatient department, integrated traditional Chinese and western medicine outpatient department and ethnic medicine outpatient department;
(4) Clinics, Chinese medicine clinics, ethnic medicine clinics, health clinics and medical offices;
(5) Specialized disease prevention hospitals (institutes and stations);
(six) community health service institutions approved by the health administrative department at or above the prefecture level.
Article 5 Designated medical institutions shall meet the following conditions:
(1) Conforming to the planning of regional medical institutions;
(2) Meeting the evaluation standards of medical institutions; (3) Abide by the laws, regulations and standards of the state concerning the management of medical services, and have a sound medical service management system;
(4) Strictly implement the medical service and drug price policies stipulated by the price departments of the state and provinces (autonomous regions and municipalities directly under the Central Government), and pass the supervision and inspection of the price departments;
(five) strictly implement the relevant policies and regulations of the basic medical insurance system for urban workers, establish an internal management system suitable for the management of basic medical insurance, and equip with necessary management personnel and equipment.