Two, in particular:
(a) online query
Computer operating environment: Apple Computer A1466Windows 10 Google Chrome 64-bit
Log into the local health insurance bureau website, you can see the details of the medical insurance card around the world, the balance of the query address list are all inside, just click into the local query medical insurance situation. Those who need to can easily see how to use the method to complete. After clicking on the relevant city, and then enter their ID number, password or health insurance card and other relevant information, you can enter the query health insurance card related to the situation.
(2) Make a phone call
In addition to online inquiries, you can also make inquiries by calling the phone. The phone number for medical insurance card inquiry is the area code of the place where the inquiry is made plus 12333. After listening to the voice prompts, select "1" to transfer to the municipal users, and then select "1" to transfer to the "manual service". "Provide my ID card number, check the correct name and unit name, then you can query the individual payment records and consumption. This phone not only can inquire about the balance of the medical insurance card, but also about the designated hospitals, medical insurance processing and make up the payment, transfer and other related issues of consultation.
(C) cell phone WeChat query
Mobile phone operating environment: Xiaomi 12 MIUI12.5.13
In the WeChat software, find the "I" menu interface, find the "wallet" inside, and then In the "wallet" inside the "city services" menu, which has "five insurance and one gold" menu bar, the following are "social security" and "public security". Underneath are the "Social Security" and "Provident Fund" query portals, just click into the "Social Security" menu bar, you can enter the "Social Security" query interface. In the inquiry interface, select "Personal Information Binding" and fill in your social security information as required. After binding personal information, return to the previous interface, select the "social security query" function, enter the social security query interface, as long as you want to query the start and end of the time, and then confirm that you can, in the query results can be seen in the purchase of five insurance, the amount of money purchased and the unit of personal contributions.
(4) Social Security Bureau query
In the local social security bureau hall window to apply for the query, only need to bring personal identification documents and medical insurance card, to the window query about the employee medical insurance information. It is also possible to make inquiries through the self-service inquiry machines in the service halls of the municipal and county medical insurance agencies.
Three, the scope of reimbursement of employee medical insurance:
(a) can be reimbursed:
1, outpatient, emergency medical expenses;
2, the cost of purchasing medicines in designated retail pharmacies;
3, emergency rescue stay and hospitalization, the hospitalization of the hospitalization of its stay within seven days before hospitalization;
4, Outpatient medical expenses for radiation therapy and chemotherapy for malignant tumors, renal dialysis, and taking anti-rejection drugs after renal transplantation.
(2) The following items are excluded from the reimbursement of urban workers' medical insurance:
1. Service items category.
1) registration fee, out-of-hospital consultation fee, medical record cost and so on;
2) outpatient consultation fee, examination and treatment expediting fee, surcharge for named surgery, quality premium fee, self-invited special nurses and other special medical services.
2, non-disease treatment program category.
1) a variety of beauty, fitness and non-functional cosmetic and orthopedic surgery;
2) a variety of weight loss, weight gain, height projects.
3) all kinds of health checkups;
4) all kinds of preventive and health care treatment programs;
5) all kinds of medical consultation, medical appraisal.
7, diagnostic and therapeutic equipment and medical materials
8, employee production, outpatient and inpatient medical reimbursement rates are different, and they both have a starting standard, over which medical expenses can be reimbursed. Not all medical items can be reimbursed, such as cosmetic items, physical examination, medical appraisal and other items of expenditure, the medical insurance will not give reimbursement.
Four, employee health insurance reimbursement rate:
(a) Outpatient reimbursement rate
After the basic urban workers' health insurance, if you are an active employee, you can be reimbursed for medical expenses of more than 2,000 yuan only after visiting outpatient clinics and emergency clinics in hospitals, and the reimbursement rate is 50 percent. If you are a retiree under 70 years old, you can be reimbursed for expenses over 1,300 yuan, and the reimbursement rate is 70%. If the retiree is over 70 years old, expenses over $1,300 can be reimbursed the reimbursement rate is 80%. And no matter which category of people, the maximum amount of expenses paid for outpatient and emergency large medical bills is 20,000 yuan.
(2) Reimbursement rate for hospitalization
At present, the starting amount is 1,300 yuan for the first time in a year when using the basic medical insurance to pay for it, regardless of whether the person is an active employee or a retiree. For the second and subsequent hospitalizations, the starting amount is set at 50%, which is RMB 650. And the maximum payment from the Basic Medical Insurance Co-ordination Fund (for hospitalization expenses) in a year is currently 70,000 yuan.
(C) hospitalization starting standard
1, tertiary including tertiary hospitals: 700 yuan within a year for multiple hospitalizations starting payment in order of 500 yuan, 400 yuan, 300 yuan employee health insurance reimbursement ratio 2016.
2, secondary including secondary specialized hospitals: 600 yuan within a year for multiple hospitalizations starting payment in order of 400 yuan, 300 yuan, 200 yuan.
3, the first level including the following hospitals: 500 yuan within a year multiple hospitalization starting payment in order of 300 yuan, 200 yuan, 100 yuan.
4, in the starting line above the maximum payment limit below, Category A and general medical fees for active employees pay 85%
5, retirees pay: 90%. Class B drugs pay 75% high precision pay 70%.
6, employee health insurance chronic and special diseases, major diseases, the annual starting standard is 700 yuan. Category A and general diagnosis and treatment paid 80%, Category B is 75% highly sophisticated 70%.