Using the medical insurance card in designated hospitals: (1) When you present your medical insurance card to prove your identity and register at a designated hospital, 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 you will only have to pay the balance of the card or the cash for the out-of-pocket expenses when you are settling the bill. (2) hospitalization reimbursement, there is a starting line (the starting standard is generally 10% of the average annual salary of the city's employees in the previous year), that is, the starting line of money need to pay for their own, more than the starting line of the portion of the reimbursement according to the provisions of the local health insurance, reimbursement rates are different everywhere, and different hospitals and different projects are not the same, about 80%, you can go to the local labor security in detail. The company's website has been updated with the latest information on this topic.
The medical insurance card (hereinafter referred to as the medical insurance card) is a special card for the medical insurance personal account, with the personal identity card as the identification code, stored in the record of the personal identity card number, name, gender, and the account of the allocation of funds, consumption and other detailed information. The medical insurance card is organized by the local designated agent bank, which is a kind of multi-functional debit card of the bank. After the payment of contributions by the insured unit, the Medical Insurance Office (hereinafter referred to as the Medical Insurance Office) will commission the bank to pay the portion of the individual account to the insured employee's personal medical insurance card at the end of the month.
If a patient with a health insurance card is sick and needs to go to the hospital, the process of going to a designated health insurance unit with a health insurance card is as follows: When a participant is sick, he or she can go directly to a local designated medical institution with a health insurance handbook and IC card. The general procedure is: with health insurance manual and IC card - hospital health insurance office registration - audit verification card - pay hospitalization deposit - hospitalization - for out-of-pocket items need to be agreed and signed by the patient - cash or IC card settlement of the starting standard and out-of-pocket proportion of the out-of-pocket portion of the first - within the scope of co-ordination of the hospital first advances - settlement of the discharge.
How to choose a designated hospital for reimbursement by medical insurance card?
Medicare cards are bundled with designated hospitals, so how many designated hospitals can each person choose at most? How to choose? What is the basis for selection? Why do I have to choose a designated hospital? The specific provisions of the medical insurance policy are as follows:
Basic medical insurance implementation of fixed-point medical institution management, allowing the insured person in the qualification of the fixed-point medical institutions within the scope of the choice of personal medical fixed-point medical institutions, to a large extent, for the convenience of the insured person to seek medical treatment.
When the insured person chooses the designated medical institution for medical treatment, not only does it take into account the needs of comprehensive and specialized, Chinese and Western medicine, and primary and advanced; moreover, it also expands the right of the insured person to choose his/her own designated medical institution for medical treatment in quantitative terms, and permits him/her to put forward his/her intention of changing his/her designated medical institution according to his/her medical condition. Specific provisions are as follows:
I. Specialized medical institutions and traditional Chinese medical institutions that have obtained the qualification of designated medical institutions can be used as the designated medical institutions for all the participants in the coordinated area;
II. In addition to the specialized medical institutions and traditional Chinese medical institutions that have obtained the qualification of designated medical institutions, the participants can also choose another three to five medical institutions at different levels, and the coordinated area that has the ability to manage them can also choose the number of medical institutions for the participants to choose from. The number of selected medical institutions can be expanded if there is a coordinating area that has the ability to manage them;
Thirdly, the insured can request a change of the selected designated medical institution after one year.
How do I choose a designated hospital?
The medical insurance manual is mainly to do the designated hospital control. In accordance with the principle of "proximity, convenient management", each person can, in principle, in the unit and residence of the district or county of the basic medical insurance designated medical institutions within the scope of any choice of four medical institutions, of which there must be a primary designated medical institutions (including community health service centers and stations, factories, mines and colleges and universities within the medical institutions). All designated hospitals labeled as "first class" and "other" in the "hospital level" are primary care designated hospitals.
Five hospitals (4+1) in the health insurance handbook*** means that you can choose four designated hospitals (one of which must be a primary community hospital) and one community service center. Note that this 5th one is a community service station, which is just a service point opened by the community hospital, not the community hospital itself. In general, it is sufficient to choose four designated hospitals.
Why are insured persons allowed to freely choose their designated hospitals?
The main reason for allowing participants to choose the designated hospitals in the management of designated medical institutions is to enhance the ability of the demand side to dominate the competition. Due to the asymmetry of information between the supply and demand sides of the medical service market, the medical service market has a strong supply-side monopoly. In the management of fixed-point medical institutions, it is necessary to introduce a demand-side-led competition mechanism in the field of medical services, and to form competition not only among medical institutions, but also between medical institutions and pharmacies. Without competition, the level and quality of medical services will not go up and the cost of medical services will not come down.
The contract hospitals implemented in the past in the management of public and labor insurance medical care, although also a kind of fixed-point management, but the fixed-point medical institutions for employees are chosen by the employers, the employees do not have any right to choose, but to strengthen and consolidate the contract "monopoly" position. With the development of China's health care, people's demand for medical services is also diversified, multi-level development trend, people not only pay attention to the quality of medical services, but also on the price of medical services, medical environment and service attitude is more important.
In the basic medical insurance designated medical institutions management, although the patient can not choose to get what kind of medical services, but in the designated range of independent choice of medical institutions, choose to provide services to the doctor. In this way, if the services provided by the medical institution cannot meet the needs of patients, the cost is too high, the quality is not good, the consultation is inconvenient or the service attitude is not good, the insured person can enter the other medical institution's "door" in order to obtain satisfactory services. This will promote the medical institutions to improve the quality of service on all fronts, improve the service attitude and access conditions, reduce and control medical costs, and attract the insured to seek medical treatment.
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