The Beijing Municipal Bureau of Human Resources and Social Security issued a "notice on doing a good job of urban residents of the work of the major disease insurance", out-of-pocket expenses exceeding 50,000 yuan and then 60% without a cap.
The Notice specifies the reimbursement rate for major medical insurance, taking into account the fact that urban residents are mostly the elderly, children, the disabled and other special groups, so the reimbursement of major medical insurance is designed in accordance with the principle of not capping, and the implementation of the "segment calculation, cumulative payment".
Both outpatient and inpatient costs are included in the reimbursement scope of the medical insurance for the cumulative calculation of the starting line above the cumulative 50,000 yuan of out-of-pocket medical expenses, reimbursed by the Fund 50%; more than 50,000 yuan of out-of-pocket medical expenses, reimbursed by the Fund 60% of the medical insurance, there is no cap line.
Annual reimbursement of expenses in April will be credited to the participant passbook, for the convenience of participants, the "Notice" clearly reimbursement of medical expenses of patients with major medical insurance, do not have to declare, by the city's health insurance, social security agencies through the health insurance information system, automatic audit, eligible for reimbursement of the conditions of the major medical insurance participants only need to wait for the agency's notification can be.
It is reported that in the future, the district and county health insurance agencies will start on February 15 each year to audit the previous year's major medical insurance costs, information matching, medical assistance deductions, etc., and before March 15, will enjoy the payment of major medical insurance treatment of the person's notice of payment transmitted to the district and county social security agencies. in April, by the district and county social security agencies to pay the participant's reimbursement costs of major medical insurance. The reimbursement fees for major illnesses will be credited to the bank passbook in which the participant's contributions are deducted.
For some participants who do not have a bankbook for contributions, the social security agency will credit the reimbursement fees to the social security office where the participant's household registration is located, and the social security office will notify the participant to collect the reimbursement fees in a timely manner. When collecting the payment, the participant should bring along his/her identity card or household registration book and social security card.
Six medical out-of-pocket expenses
1. Medical expenses below the starting standard of the Basic Medical Insurance Fund for Urban Residents
2. Medical expenses above the starting standard and below the maximum payment limit of the Basic Medical Insurance Fund for Urban Residents, which should be borne by the individual in accordance with the proportion of the medical expenses
3. Medical expenses incurred in checkups and treatments with the use of large-sized medical equipments and the cost of a single item of 200 yuan (inclusive), or the cost of a single item of 200 yuan (inclusive). Medical expenses that should be borne by the individual first if the cost of a single item is 200 yuan or more
4. Medical expenses that should be borne by the individual first if they are in Category B of the catalog of diagnostic and treatment items and the scope of medical service facilities of the basic medical insurance policy
5. Medical expenses that should be borne by the individual first if they are in Category B of the Drug Catalog of Beijing Municipal Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance
6. p>6. The medical expenses above the maximum payment limit of the basic medical insurance fund for urban residents can be included in the scope of reimbursement with reference to the payment regulations of the basic medical insurance fund for urban residents, as well as the medical expenses in line with the above 3, 4 and 5 in the table
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