Today, we're going to tell you how to use your health insurance card well!
What's the difference between the two accounts?
The employee health insurance has two accounts: the integrated account and the individual account, they pay the scope of the difference, the individual account is mainly used to pay for general outpatient expenses, the integrated account is mainly used to pay for hospitalization and some of the costs of outpatient treatment of chronic diseases.
(Note: the contribution rate varies from place to place)
The individual account can pay for the following expenses
Outpatient and emergency medical expenses;
Purchase of medicines at designated retail pharmacies;
Medical expenses below the starting standard of the basic medical insurance co-ordination fund;
Medical expenses above the starting standard of the basic medical insurance co-ordination fund; and
Medical expenses below the starting standard of the basic medical insurance co-ordination fund.
The individual account is mainly used to pay for general outpatient expenses. Medical expenses exceeding the starting standard of the Basic Medical Insurance Coordination Fund, which should be borne by individuals according to the proportion.
The co-ordination account mainly pays for the following expenses
Medical expenses for hospitalization;
Medical expenses within 7 days of hospitalization for those who are hospitalized after emergency rescue and hospitalization;
Outpatient medical expenses for malignant tumors radiation therapy and chemotherapy, kidney dialysis, and anti-rejection medication after kidney transplantation.
2. How is the medical card reimbursed?
Medicare card in hand, see the doctor without worry?
too young too simple!
Medicare reimbursement sets are notoriously deep
(Note: The reimbursement rates are different across the country, and in general, the better the reimbursement rates are, the lower the reimbursement rates are).
Starting line
The cost below the starting line, also called the absolute deductible, is your responsibility.
Reimbursement cap
According to the health insurance policy, medical expenses below the cap are reimbursed, and those above are not covered by health insurance.
Out-of-pocket expenses
This refers to some imported medicines, special drugs, medical equipments and medical services that are not reimbursed by the medical insurance, which you pay for yourself.
3. 2 common reimbursement scenarios for health insurance
Outpatient visits
Outpatient visits to buy medication to brush up on your personal account, and if you are brushed through, or if you buy medicines that are not covered by the reimbursement, you'll have to pay for them out of your own pocket.
An example
Small Wu spent 8,000 yuan in one year*** at a designated tertiary hospital, and 600 yuan at his own expense, the local outpatient reimbursement rate and maximum limit are as follows
Small Wu can be reimbursed for the cost of the = (8,000 - 1,800 - 600) × 70% = 3,920 yuan
Hospitalization
Hospitalization medical expenses are reimbursed by the integrated account, which means "expenses within the scope of the social security system", and the medical insurance cannot reimburse the out-of-pocket expenses or self-payment.
An example
The heart stent surgery in a tertiary care hospital*** cost 120,000 yuan, of which 90,000 yuan was in the catalog and 30,000 yuan was out-of-catalog, the local workers' health insurance hospitalization cost reimbursement ratio and maximum limit are as follows
How much can the cost of the surgery be reimbursed? Let's calculate the coordinated reimbursement portion = (90,000-1,300) x 95% = 84,265, not exceeding the maximum limit of 100,000, then, Xiaozhou can be reimbursed for 84,265 yuan
Note
Local health insurance reimbursement policies are not the same, and the standard of contribution, reimbursement rates, reimbursement limits and so on are not the same. Specific reimbursement, the official policy of each place shall prevail, the above data is for reference only.
Some tips to maximize your reimbursement
1. You need to know what you're getting into before you go to the doctor
The doctor will tell you what you need to do to get the most out of your medical treatment
The doctor will tell you that he or she is not going to be able to get you out of the hospital.
3. Higher reimbursement rate
From the situation in most areas, hospitalization in primary care, the starting line is lower, the reimbursement rate is higher, so some common minor illnesses or to go there to see cost-effective
4. transfer procedures in accordance with the provisions of the do more money
The rural patients often encounter such a The first thing you need to do is to get your hands on a new computer, and you'll be able to get it to work for you, so you'll be able to get it to work for you. Because of this, the reimbursement rate will be lowered and the starting line will be raised, and you will have to pay again.
The above, is to share with you, about the health insurance card of some of the small knowledge, I hope you can pay attention to.