Social security reimbursement refers to the proportionate reimbursement by social insurance of the costs of medical expenses, maternity expenses and treatment of work-related injuries of employees and residents. Social security reimbursement mainly includes three parts: maternity insurance reimbursement and work injury insurance reimbursement. Social health insurance reimbursement methods vary somewhat from place to place.
Medical reimbursement
I. Outpatient clinic
(1) The use of medical insurance cards to visit outpatient clinics will be settled in real time without reimbursement.
(2) If you visit the outpatient clinic without a medical insurance card, please use the Beijing Medical Insurance Handbook (medical blue book).
1. Scope of reimbursement: general outpatient and emergency expenses incurred by the insured person at the medical insurance designated hospitals or specialized hospitals of his/her choice, Chinese medicine hospitals and Class A hospitals.
2. Outpatient starting line: general outpatient and emergency expenses incurred in a natural year exceeding 1,800 yuan in total.
3. Reimbursement rate: 70% for hospitals and 90% for communities for the portion above 1800 yuan, and the ceiling line: 20,000 yuan.
4. Required materials:
Original ID card;
Original medical diagnosis certificate;
Original medical documents such as outpatient medical records, report cards of examination and test results;
Original receipts of fees for general outpatient services and emergency services,
Original list of outpatient expenses or original prescriptions (the prescriptions are pasted on the back of the receipts according to the date). ).
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