Refers to the behavior of social insurance to compensate employees and residents for medical expenses, maternity expenses and work-related injury treatment expenses in proportion. Social security reimbursement mainly includes maternity insurance reimbursement and work-related injury insurance reimbursement. The reimbursement methods of social medical insurance vary from place to place.
I. Outpatient service
(a) the use of medical insurance card to outpatient treatment, real-time settlement, no reimbursement.
(2) Please use Beijing Medical Insurance Manual (medical blueprint) for outpatient treatment without medical insurance card.
1. Reimbursement scope: general outpatient and emergency expenses incurred by the insured in designated hospitals or specialized hospitals, traditional Chinese medicine hospitals and tertiary hospitals selected by individuals.
2. Outpatient deductible line: the total emergency expenses of general outpatient service exceed 1.800 yuan in a natural year.
3. Reimbursement ratio: 70% for the hospital, 90% for the community, and the top line: 20,000 yuan.
Second, hospitalization.
1. Reimbursement scope: hospitalization expenses incurred by the insured in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by the individual.
2. Inpatient deductible line: The standard of the first hospitalization deductible line in a natural year is 1.300 yuan, with 650 yuan as the unit each time.
3. Reimbursement ratio: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total reimbursement of 300,000 yuan for hospitalization.
4. Handling process: Please use the Beijing Medical Insurance Manual for medical treatment. If the unit pays in full, the individual can go through the hospitalization formalities only by paying part of the hospitalization advance payment, and the medical expenses incurred should meet the scope of medical insurance. When leaving the hospital, the hospital and the individual will settle the expenses themselves, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center.