Medicare Reimbursement Scope and Ratio:
1. The reimbursement of the medical insurance card is limited to medical expenses above hospitalization in designated hospitals due to illness and some accidents. The reimbursement formula is: (total cost - threshold fee - out-of-pocket expenses - overspending) * (75 + age * 0.2)%, under normal circumstances, the actual reimbursement rate ranges from 20 to 60%.
Out-of-pocket expenses are not reimbursed, 80% of reimbursement is for Class B drugs, there is a limit on bed charges, and some examination and treatment fees are not reimbursed according to regulations.
2. The reimbursement amount of the health insurance card is 4 times of the average salary of the local social workers (the cumulative value in 1 year).
3. The money in the card can be used to buy medicines at designated pharmacies and to pay for outpatient and emergency treatment, but it is not reimbursed because the money in the card is the money in the individual account of the health insurance.
4, major medical insurance reimbursement, the insured person suffering from a serious illness, in the city health insurance designated medical institutions, in line with the city's health insurance regulations of the individual portion, included in the scope of payment of residents of the major medical insurance, the major medical insurance funds reimbursement of 50%.
According to your situation:
1, your situation is not within the scope of medical insurance reimbursement. Because the company did not give health insurance before, of course, the health insurance will not reimburse you, but this is a clear violation of the company, the company is responsible for and punished.
2, Beijing's new for health insurance, health insurance card to hand, the next month in effect, individuals can set up four designated hospitals, can be adjusted once a year to go to the three hospitals without the need to set up treatment, go to the two hospitals do not set up reimbursement.
3, you take the health insurance card to the hospital without the need to advance funds, only need to pay your personal part.
4, hospitalization starting line: 1300 yuan, after 85% reimbursement, the annual amount of 170,000 yuan. Outpatient starting line: $1,800, 70% reimbursement thereafter, annual burden of only 20,000 yuan.
5, can not. Social security and rural medical insurance can only buy a kind of, all medical reimbursement will only be reimbursed once with the invoice.
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Urban residents who are hospitalized for more than two times in a billing year will not be charged the starting standard fee from the second hospitalization. The starting standard fee will no longer be charged. If they are transferred or hospitalized for more than two times, the difference will be made up in accordance with the prescribed starting standard of the hospital to which they are transferred or re-admitted.
On January 12, 2016, the State Council issued the Opinions on the Integration of the Basic Medical Insurance System for Urban and Rural Residents, which calls for the integration of the basic medical insurance system for urban residents (hereinafter referred to as the urban residents' medical insurance) and the new type of rural cooperative medical care (hereinafter referred to as the New Rural Cooperative Medical Care), and the establishment of a unified basic medical insurance (hereinafter referred to as the urban-rural residents' medical insurance) system for urban and rural residents.
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