The smart medical insurance app is a mobile application that provides the insured with a series of services such as medical treatment, drug purchase, payment and personal health. The main purpose is to improve the public service level and capabilities of medical insurance, solve hot and difficult issues in people's livelihood, promote the innovative development of human resources and social security, and create a safe, intelligent and convenient Internet humanistic and social ecology.
The use of smart medical insurance is mainly divided into two main steps: downloading and installation and real-name authentication
Medical insurance generally refers to basic medical insurance, which is to compensate workers for the risks caused by disease A social insurance system established for economic losses.
Medical insurance funds are established through employer and individual contributions. After insured persons incur medical expenses when they are sick, the medical insurance agency will provide them with certain financial compensation.
Reimbursement conditions
Article 28 of the "Social Insurance Law" stipulates that medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be in accordance with The state stipulates that payment shall be made from the basic medical insurance fund.
According to the basic requirements for the payment of basic medical insurance benefits in my country, insured persons who go to medical insurance institutions to reimburse themselves for medical expenses must generally meet the following conditions:
(1) Insured persons must go to the designated medical institutions of the basic medical insurance to purchase medicines, or go to designated retail pharmacies determined by the social insurance agency to purchase medicines with medical prescriptions issued by doctors in designated hospitals.
(2) The medical expenses incurred by insured persons during the process of medical treatment must comply with the scope and payment standards of the basic medical insurance drug catalog, diagnosis and treatment items, and medical service facility standards before they can be covered by the basic medical insurance. Funds are disbursed in accordance with regulations.
(3) Among the medical expenses of insured persons that are within the payment scope of basic medical insurance, the portion of the expenses above the minimum payment standard of the social medical co-ordination fund and below the maximum payment limit shall be paid by the social medical co-ordination fund in a uniform proportion .
Reimbursement ratio
1. Outpatient and emergency medical expenses: The total medical expenses within the scope of basic medical insurance for active employees during the year (January 1st to December 31st) exceed 2,000 Yuan and above.
2. Settlement ratio: During the contract period, 50% of the dispatched personnel's expenses exceeding 2,000 yuan will be reimbursed, and the individual will pay 50%; the maximum amount of outpatient and emergency reimbursement paid to dispatched personnel in one year is 20,000 yuan.
3. Insured persons must properly keep the outpatient medical receipts (including receipts for large amounts and below, the bottom of prescriptions, etc.) for medical treatment at designated hospitals as proof of medical expense reimbursement.
4. Outpatient medical treatment for three special diseases: when the insured person needs to seek medical treatment in an outpatient clinic after radiotherapy and chemotherapy for malignant tumors, renal dialysis, or kidney transplantation, the insured person shall The designated secondary and tertiary hospitals for medical treatment will issue a "Disease Diagnosis Certificate", fill out the "Medical Insurance Special Disease Application Approval Form", and report it to the district medical insurance center for approval and filing.
Outpatient medical treatment and medicine collection for these three special diseases are limited to approved designated hospitals, and cannot be purchased at designated retail pharmacies. If the medical expenses incurred fall within the prescribed range for outpatient special diseases, they will be settled with reference to hospitalization.
5. Inpatient medical treatment.
You must have paid enough medical insurance for 20 years before you can enjoy medical insurance reimbursement after retirement.
The reimbursement ratio range of medical insurance varies in different places. Please refer to local policy regulations for details.