The in-service employees of a unit usually have a medical insurance card belonging to them, which can be used for reimbursement after the occurrence of medical treatment. In fact, the medical card is a tool used by urban workers to reimburse them after they have taken out employee medical insurance. So, what kind of medical conditions can be reimbursed? The following is the scope of reimbursement for employee health insurance.
Employee health insurance reimbursement scope:
First, the employee health insurance treatment:
Hospitalization starting standard: third-class hospitals, including third-class hospitals: 700 yuan a year, the starting point of multiple hospitalization in order to 500 yuan, 400 yuan, 300 yuan.
Level II including secondary specialized hospitals: 600 yuan within a year of multiple hospitalization starting payment in order of 400 yuan, 300 yuan, 200 yuan.
First-level hospitals including the following: 500 yuan for multiple hospitalizations within a year starting payment in order of 300 yuan, 200 yuan, 100 yuan.
Second, the proportion of employees' medical insurance co-ordination payment:
In the starting line above the maximum payment limit below, Category A and general medical fees for in-service employees to pay for 85%
Retirees to pay: 90%. Class B drugs pay 75% high precision pay 70%.
Third, the employee health insurance major illnesses starting standard:
Employee health insurance chronic and special diseases, major illnesses, the annual starting standard is 700 yuan. Category A and general diagnosis and treatment payment 80%, Category B is 75% high precision 70%.
Maximum payment limit: for 50,000 yuan (including inpatient + outpatient chronic diseases + special diseases + major diseases)
It is important to note that the following items are no longer within the scope of reimbursement for medical insurance only:
(a) service category. (1) registration fee, out-of-hospital consultation fee, medical record cost, etc.; (2) visit fee, examination and treatment expedited fee, named surgery surcharge, quality premium fee, self-requested special nurses and other special medical services.
(B) non-disease treatment program category. (1) a variety of beauty, fitness items and non-functional cosmetic, orthopedic surgery; (2) a variety of weight loss, fat, height projects. (3) a variety of health checkups; (4) a variety of preventive, health care diagnostic and treatment programs; (5) a variety of medical consultation, medical appraisal.
(C) diagnostic equipment and medical materials. (1) the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser therapy and other large medical equipment for examination and treatment programs; (2) glasses, dentures, prosthetic eyes, prosthetics, hearing aids and other rehabilitative devices; (3) a variety of health care for their own use, massage, inspection and treatment equipment; (4) the provincial price departments can not be charged separately for disposable medical.
(D) treatment program category. (1) all types of organ or tissue transplantation of organ source or tissue source; (2) in addition to kidney, heart valve, cornea skin, blood vessels, bone, bone marrow transplantation, other organs or tissue transplantation; (3) myopic orthopedics; (4) qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other complementary therapeutic projects.
(E) Other. (1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; (2) a variety of scientific research, clinical verification of the diagnosis and treatment program.
After the medical treatment, the insurance workers can be reimbursed according to the following process:
First, the hospitalized patients are hospitalized in the designated medical institutions in the region
First, present the medical insurance card, and then according to the level of the hospital to pay a certain amount of threshold fee, and then go to the hospital's medical insurance billing office after the hospital can be entitled to the medical insurance treatment.
The reimbursement procedure for patients hospitalized in other places
(1) Declaration and settlement information
Please bring the following information for reimbursement of hospitalization in other places
1) Hospitalization invoice (with seal)
2) Hospitalization expense list (with seal)
3) Discharge record (with seal)<
4, a copy of the voluntary letter of using drugs and special treatment items other than those listed in the catalog (stamped)
5, medical insurance card
6, "Wuhan Caidian District Urban Workers' Medical Insurance Referral Order" with complete formalities
(2) Settlement of payment
Procedures for hospitalization in a foreign country If the procedures for hospitalization in a different city are complete, you can settle the reimbursement after 5 working days with the receipt voucher and your own ID card (a substitute person needs to provide a substitute person's ID card). Reimbursement is suspended from the 28th to the end of each month and resumed from the first day of the following month.
Third, outpatient reimbursement procedures for patients with serious illnesses
(a) reimbursement time
hypertension and diabetes outpatient reimbursement of patients with serious illnesses: the first quarter for the month of March; the second quarter for the month of June; the third quarter for the month of September; the fourth quarter for the month of December.
Reimbursement for outpatient critically ill patients with other conditions is monthly.
(B) Declaration of settlement information
1, outpatient medical receipts; 2, Chinese prescription scratch price and stamp; 3, check with the original examination report card.
(C) Settlement
The formalities are complete 5 working days after the settlement of the amount of reimbursement directly into my bank passbook.
The amount of reimbursement will be transferred directly to your bank book after 5 working days.