Settlement procedures for hospitalization and outpatient treatment of special diseases:
1. The designated medical institutions will submit the expense statement, hospitalization statement and relevant information of patients discharged from hospitals in the previous month to the medical insurance agency before the 10th day of each month, which will review and approve them and then serve as the basis for the monthly advance appropriation and year-end final accounts.
2. The medical insurance agency makes monthly advance payments for the previous month's hospitalization and outpatient treatment of special diseases.
3. Participants who are recognized as suffering from special diseases should go to one of the designated medical institutions designated by the labor security department for medical treatment and purchase of medicines, and the medical expenses incurred will be recorded directly in the accounts and settled instantly.
4, the scope of reimbursement: medicine, auxiliary examination, electrocardiogram, X-ray fluoroscopy, film, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees limit of 200 yuan; surgical expenses (with reference to the national standard, more than 1,000 yuan reimbursement at 1,000 yuan).
5. When the elderly over 60 years old are hospitalized in health centers, the treatment and nursing fees are compensated at 10 yuan per day, with a limit of 200 yuan.
6. Reimbursement rate:Township health centers reimburse 60%, secondary hospitals reimburse 40%, and tertiary hospitals reimburse 30%.
Expanded Information:
Medical Reimbursement
I. Outpatient
Using a medical insurance card to visit an outpatient clinic will result in real-time billing without reimbursement. If you do not have a medical insurance card to visit an outpatient clinic, please use the Beijing Medical Insurance Handbook (medical blue book).
1. Scope of reimbursement: general outpatient and emergency room expenses incurred by the insured in the medical insurance designated hospitals or specialized hospitals, Chinese medicine hospitals and Class A hospitals of their choice.
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.
2. Hospitalization
1. Reimbursement scope: hospitalization expenses incurred by the insured in the medical insurance designated hospitals or specialized hospitals, Chinese medicine hospitals and Class A hospitals of personal choice.
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 cumulative reimbursement of 300,000 yuan for hospitalization.
4, the process: please use the "Beijing health insurance manual" when you visit the hospital, such as the unit to pay the full amount of fees, individuals only need to pay part of the hospitalization deposit, you can go through the hospitalization procedures, the medical expenses incurred should be in line with the scope of the health insurance, the hospital and the individual to clear the amount of out-of-pocket expenses when the hospital is discharged, and the amount of reimbursement of the integrated fund by the hospital and the district health insurance center settlement.