Second, the Medical Insurance Bureau:
The main functions of the Medical Protection Bureau are:
1, the development of medical insurance, maternity insurance and medical assistance medical insurance system of laws and regulations drafts, policies and planning, and standards, the development of departmental rules and regulations and organize the implementation of;
4. Formulate bidding and procurement policies for drugs and medical consumables and supervise their implementation, and guide the construction of bidding and procurement platforms for drugs and medical consumables;
5. Be responsible for the management of medical insurance administration, the public ****service system and the construction of informatization;
6. Accomplish other tasks entrusted to it by the CPC Central Committee and the State Council.
Three, extended information - medical insurance reimbursement:
1, China's medical insurance reimbursement regulations:
According to China's basic medical insurance treatment payment of the basic requirements of the insured to the medical insurance organization to reimburse their own medical expenses incurred in seeing a doctor for medical treatment, generally subject to the following conditions:
(1) The insured person must go to the designated medical institutions of the basic medical insurance to seek medical treatment and purchase medicines, or purchase medicines outside the designated retail pharmacies determined by the social insurance organization with the medical prescription issued by the doctor of the designated hospital.
(2) Medical expenses incurred by insured persons in the course of seeking medical treatment must be in accordance with the scope and payment standards of the basic medical insurance drug catalog, diagnostic and therapeutic items, and standards of medical service facilities, in order to be paid by the basic medical insurance fund in accordance with the regulations.
(3) The portion of medical expenses incurred by a participant in accordance with the scope of payment of basic medical insurance that are above the starting standard and below the maximum payment limit of the social medical insurance fund shall be paid by the social medical insurance fund in a uniform proportion.
2. Reimbursement Ratio
(1) Outpatient and Emergency Medical Expenses: the part of the medical expenses that meet the scope of the basic medical insurance within the year (January 1~December 31) of the active employees that are more than 2,000 RMB in total.
(2) Settlement ratio: 50% reimbursement for the portion of over 2,000 yuan for dispatched staff during the contract period, and 50% out-of-pocket payment by individuals; the maximum amount of outpatient and emergency reimbursement paid to dispatched staff cumulatively in a year is 20,000 yuan.
(3) Participants should keep the outpatient medical bills (including receipts and prescription bottoms for the parts below the large amount) of the outpatient consultation at the designated hospitals as the vouchers for reimbursement of medical expenses.
(4) outpatient medical treatment for three special diseases: when a participant suffering from malignant tumor radiotherapy and chemotherapy, renal dialysis, or taking anti-rejection drugs after renal transplantation needs outpatient medical treatment, the second or third level designated hospital where the participant seeks medical treatment will issue a "diagnosis certificate of disease" and fill in the "Medical Insurance Special Disease Declaration and Approval Form", which will be submitted to the district medical insurance center for approval and filing. The medical insurance center of the district for approval and filing.
The outpatient medical treatment for these three special diseases and the collection of medicines are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical fees incurred are within the scope of outpatient special diseases, they will be settled with reference to hospitalization.
(5) Inpatient medical treatment.
3. You have to pay for health insurance for 20 years before you can enjoy the health insurance reimbursement after retirement. The scope of the reimbursement rate of medical insurance varies from place to place, please refer to the local policy regulations.