Based on the number of years of insurance, base, personal social security card has a certain amount of money, to go to the designated hospital to see a doctor, will brush the social security card (like a credit card), registration, medicine are spent on social security card money.
It is not necessary to be hospitalized to give reimbursement, more than 800 yuan, can be reimbursed, as long as the individual insurance in Beijing, non-Beijing hukou, the same reimbursement.
1. When you are admitted to or discharged from the hospital, you must go to the medical insurance management window of each designated medical institution with your medical insurance IC card to go through the registration procedures for entering and leaving the hospital.
2. The starting line of the integrated fund after hospitalization of the insured is divided into three grades: 1,000 yuan for the third-level hospitals, 600 yuan for the second-level hospitals, and 400 yuan for the first-level hospitals. In a basic medical insurance settlement year, the medical fees for multiple hospitalizations are cumulative.
3. If an insured person needs to be referred to a hospital because of his condition, he must be diagnosed by the deputy chief physician or the head of the department of the designated medical institution (above the third level) and put forward the opinion of referral, and then his unit will fill in the application form, and then report to the municipal (district) social security institution for approval after the medical insurance management department of the designated medical institution has examined and agreed to carry out the procedure of referral.
4. When discharged from a designated medical institution, each designated medical institution will calculate the amount of reimbursement and the amount of personal out-of-pocket payment in accordance with the relevant policies, and the reimbursement amount will be settled by the designated medical institution and the urban social insurance agency, and the amount of personal out-of-pocket payment will be settled by the designated medical institution and the insured person himself/herself.
5. When you present your health insurance card at the designated hospital to prove your identity and register, you do not need to pay for the reimbursement first, but you can settle the reimbursement directly between the medical insurance and the hospital, and only at the billing time, you will have to use the balance of the card or pay in cash to pay for the out-of-pocket part.
Expanded:
Hospitalization reimbursement:
1. Reimbursement scope: the insured person in the individual choice of the medical insurance designated hospitals or specialist hospitals, Chinese medicine hospitals and A class Hospitalization expenses incurred in hospitals.
2. Starting line for hospitalization: the starting line for the first hospitalization in a natural year is 1,300 yuan, and 650 yuan for each subsequent hospitalization.
3. Reimbursement rate: 90% for Class I hospitals, 87% for Class II hospitals, 85% for Class III hospitals, and a total of 300,000 RMB for hospitalization.
4, the process: please use the "Beijing Medical Insurance Manual" when seeking medical treatment, if the unit pays in full, the individual only needs to pay part of the hospitalization advance payment, you can apply for hospitalization, the medical expenses incurred should be in line with the scope of medical insurance, the hospital and the individual when discharged from the hospital to clear the amount of out-of-pocket expenses, the amount of reimbursement of the integrated fund by the hospital and the district medical insurance center.
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