How to use hospitalization medical insurance reimbursement
1. First of all, when you first start hospitalization, you should explain to the hospital that it is reimbursed by medical insurance, but you must pay the medical expenses first, and then take the invoice to the medical insurance settlement window for reimbursement.
2. Pay the hospitalization expenses with the personal account of the medical insurance card, inform the hospital settlement personnel before discharge settlement, and handle it according to the normal credit card procedures. Self-funded items cannot be paid by personal account of medical insurance card.
3. The hospitalization expenses shall be settled by post-paid service items.
Proportion of reimbursement for urban medical insurance
Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.
1, students, children. In a settlement year, medical expenses less than 6,543,800 yuan+0.8 million yuan that meet the scope of reimbursement occurred. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
2. At least 70 years old and above. In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold of tertiary hospitals is 650 yuan, with a reimbursement rate of 50% and an upper limit of 2,000 yuan; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
3. Other urban residents. In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold for tertiary hospitals is 659 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan. The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.
Employee medical insurance reimbursement ratio
Generally speaking, the economic development in different regions is different, so the reimbursement ratio is different. The following is an explanation of the proportion of employees' medical insurance in Beijing.
After receiving medical insurance, if they are on-the-job employees, the medical expenses above 1800 yuan can only be reimbursed, and the reimbursement rate is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed.
No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then 700 yuan can reimburse 50%, that is, 350 yuan.
If it is hospitalization expenses, the minimum payment for employees and retirees is 1300 yuan when the basic medical insurance is used for the first time within one year in 2009. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. 1 year The maximum payment limit of the basic medical insurance pooling fund is 70,000 yuan.
The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. The proportion paid by retirees is 60% paid by employees, but those below the threshold are paid by individuals.
The medical treatment items that employees' basic medical insurance does not pay are mainly those that are clinically unnecessary and have uncertain curative effects, and those that need special medical services, including services such as registration fees, non-disease treatment items such as beauty, therapeutic equipment and medical materials hearing AIDS, magnetic therapy and other types of infertility treatment.
Reimbursement scope of medical insurance
The medical treatment items that employees' basic medical insurance does not pay are mainly those that are clinically unnecessary and have uncertain curative effects, and those that need special medical services, including services such as registration fees, non-disease treatment items such as beauty, therapeutic equipment and medical materials hearing AIDS, magnetic therapy and other types of infertility treatment. According to the scope of the national basic medical insurance treatment project, the details are as follows:
Service project class. Registration fee, out-of-hospital consultation fee, medical record fee, etc. ; Special medical services such as visiting fees, urgent fees for examination and treatment, additional fees for roll call surgery, high-quality and good-price fees, and self-invited special care.
Non-disease treatment program. All kinds of beauty, bodybuilding and non-functional plastic surgery, plastic surgery, etc. All kinds of weight loss, weight gain and height increase projects. Various health checks; Various preventive health care diagnosis and treatment projects; All kinds of medical consultation and medical appraisal.
Diagnostic equipment and medical materials. Examination and treatment projects carried out by large medical equipment such as positron emission tomography device, electron beam cT and ophthalmic excimer laser therapeutic instrument; Rehabilitation equipment such as glasses, dentures, artificial eyes, artificial limbs and hearing AIDS; All kinds of self-use health care, massage, examination and treatment equipment; Provincial price departments stipulate that one-time medical treatment cannot be charged separately.
Category of treatment items. The organ source or tissue source of various organ or tissue transplants; Transplantation of organs or tissues other than kidneys, heart valves, corneal skin, blood vessels, bones and bone marrow; Orthopedic surgery for myopia; Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
Others. Various infertility and sexual dysfunction diagnosis and treatment projects; Various scientific research and clinical verification diagnosis and treatment projects.
Non-reimbursement scope of medical insurance
1, medical treatment by oneself, drugs purchased by oneself, drugs that cannot be reimbursed according to the provisions of public medical care, do not meet the medical expenses of family planning;
2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees, heating and cooling fees, ambulance fees, special care fees and other expenses;
3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;
4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;
5, within the scope of reimbursement, beyond the limit.
What information should be provided for reimbursement of hospitalization medical expenses?
1, copy of IC card and ID card for medical insurance reimbursement;
2. Original invoice for regular hospitalization;
3, stamped with the seal of the hospital medical expenses summary list;
4. Discharge certificate or diagnosis certificate;
5, stamped with the seal of the hospital medical records copy.
6. Medical personnel who are transferred to other places for reimbursement of medical expenses need to bring social insurance referral application forms when hospitalized in other places; Resettlement personnel reimbursement of medical expenses also need to carry a copy of the "application form for urban workers' basic medical insurance resettlement personnel"; Insured persons who are hospitalized in this city also need to carry the reasons issued by the hospital for failing to pass the system settlement.
Matters needing attention
The name displayed on the invoice and the copy of the medical record should be consistent with the name displayed on the ID card;
Copies of medical records should include copies of medical orders and reports as the basis for hospitalization diagnosis;
Outpatient invoices are not accepted.