Off-site health insurance is the focus of attention in recent years, then Hubei off-site health insurance reimbursement ratio for how much? Is it clear to everyone? Today we will come together to understand it!
In 2015, Li Jiachuan, who lives in Xianning, was discharged from the Wuhan Army General Hospital. What makes him happy is not only physical recovery, but also the original cumbersome health insurance reimbursement procedures no longer exist. "Directly brush the medical insurance card settlement, do not have to go back to reimbursement, really convenient."
At the end of 2014, the province fully realized the medical insurance province-wide network settlement. The first time I saw this, I was able to see a lot of people who had been in the same room for a long time, and I was able to see a lot of people who had been in the same room for a long time. This time, Li Jiachuan only need to settle part of the personal expenses, the rest of the costs by the medical insurance agency and the designated hospitals direct settlement.
Li Jiachuan, 68, was found to have liver cancer in September last year at Xian'an Hospital. After discussing with his family, he went to the Wuhan Army General Hospital on January 8, 2015 for interventional treatment of liver cancer, and was discharged. "Total *** spent more than 22,000 yuan, their own out of 5,700 yuan, settled on the spot, before and after only a quarter of an hour, quite fast!" Li family legend.
According to statistics, in 2015, the province's cities (states), 35,300,000 people to realize off-site to Wuhan City designated medical institutions for medical treatment, instant settlement rate of 97.2%, settlement of the total medical costs of 940 million yuan, the reimbursement of the proportion of the policy reached 66.2%.
Li Jia Legend, four years ago, the same to Wuhan to see a doctor, he not only their first money advance, take the ticket back to Xianning reimbursement, but also encountered a lot of trouble, "either the information did not get all, or where less stamped a chapter, back and forth a few times, time-consuming and laborious."
In 2015, the provincial government to the province of different places in the medical network instant settlement into the people to do practical things for one of the commitments. The provincial human resources and social affairs department identified 50 medical fixed-point service organizations in the province according to the flow of people seeking medical treatment in other places, the professional characteristics of medical institutions and regional distribution, so as to provide more efficient and convenient medical services for people seeking medical treatment in other places. The human resources and social services department has also established a provincial online monitoring system for medical treatment in a different place, through the province's unified medical insurance drug directory, diagnosis and treatment (materials) items, service facility standards, disease code library, medical insurance doctor database, in accordance with the monitoring rules, to achieve the province's online monitoring of the medical service behavior of the medical treatment in a different place, and to the doctor's violation of the phenomenon of instant prompting and control, to ensure the safe operation of the fund. "By the end of 2015, 'network settlement' will cover all designated medical institutions for different-location medical treatment in the province, so that more patients can benefit." The provincial Department of Human Resources and Social Affairs said.
Reimbursement ratio and process
Reimbursement need to bring the following information: 1. the original ID card or social security card; 2. the original certificate of diagnosis of disease issued by the designated medical institution specialist doctor; 3. the original outpatient medical records, inspection, test results report card and other medical information; 4. the original financial, tax unified medical institutions outpatient fee receipts; 5. the outpatient clinic of the hospital's computer printouts Expenses detailed list or the doctor issued a prescription for the payment of the original; 6. designated pharmacies: tax unified invoice for the sale of goods and computer printout of the original list; 7. If it is on behalf of the person to handle the need to provide the original identity card of the person on behalf of.
Bring all the above information to the local social security center relevant departments to apply for processing, after review, complete information, meet the conditions, can be instantly processed. When the applicant applies for reimbursement of outpatient medical expenses, the amount transferred to the individual account of medical insurance in the current social security year will be deducted first, and then the amount to be reimbursed will be approved.
Inpatient medical insurance reimbursement process and notes:
1. When you are admitted to or discharged from the hospital, you must go to the medical insurance management window of each designated medical institution with your medical insurance IC card to go through the registration procedures for entering and leaving the hospital. When you are hospitalized, you have to pay the medical fee deposit in advance, and then you have to pay more or less after you are discharged from the hospital. Medical fees incurred before hospitalization registration are not covered by basic medical insurance. If you are hospitalized due to an emergency and cannot complete the hospitalization registration procedures in time, you should go to the medical insurance management window on the next day after your admission to the hospital with a certificate of emergency to complete the hospitalization procedures (postponed in case of holidays), and you will be responsible for the medical fees incurred beyond the time limit.
2. The starting line of the integrated fund after the hospitalization of the insured: the starting line varies from place to place and is generally 10% of the average annual salary of the city's employees in the previous year, and the medical fees for multiple hospitalizations are calculated cumulatively in a basic medical insurance settlement year.
3. If the insured person needs to be referred or transferred to another hospital due to his condition, he must be diagnosed by the deputy chief physician or the head of the department of the designated medical institution of the third level or above and then put forward the opinion of referral, and then his unit will fill in the application form, which will be reviewed and agreed by the management of the medical insurance department of the designated medical institution and reported to the municipal (district) social security institutions for approval to carry out the procedures of referral.
The transfer is limited to the provincial special hospitals, the cost of which is first advanced by the person, and its reimbursement rate should be 10% first, and then calculate the reimbursable amount in accordance with local regulations.
4. When discharged from a designated medical institution, each designated medical institution will calculate the amount of reimbursement and the amount of personal out-of-pocket payment in accordance with the relevant policies, and the reimbursement will be settled by the designated medical institution and the urban social insurance agency, while the amount of personal out-of-pocket payment will be settled by the designated medical institution and the insured person himself/herself.
Extended reading: Hubei unified urban and rural health insurance from next year, the province of instant settlement of medical treatment
Hubei Provincial Government Office recently released "Hubei Province, the integration of urban and rural residents of the basic medical insurance system work program" (hereinafter referred to as the program), the province's urban residents of health insurance and the new rural areas to complete the merger, the implementation of a unified urban and rural residents of the health insurance system, the hospitalization reimbursement ratio uniformly at about 75 percent.
According to the program, before the end of August this year, the completion of institutions, functions, personnel integration and transfer of assets; before the end of September, the study and formulation of urban and rural residents' health insurance related policies; before the end of the year, the completion of the audit of the urban residents' health insurance fund and the New Rural Cooperative Fund, the development of the urban and rural residents' health insurance information system and the docking of systems with the health care institutions; in 2017, the province's implementation of a unified urban and rural residents' health insurance system .
As for the management system, the management functions of the new rural cooperative undertaken by the health planning department and the management functions of the urban residents' medical insurance undertaken by the human resources and social security department will be merged and unified by the human resources and social security department. The organization, establishment, personnel and funding of the health department in relation to the new rural cooperative will be transferred to the human resources and social security department as a whole. After the institutional integration and before the new system comes into operation, the urban residents' health insurance and the New Rural Cooperative will be managed in a unified manner, run separately, and *** accounted for. During the period of system integration, no adjustment shall be made to the policies of the urban residents' medical insurance and the new rural cooperative.
The integrated health insurance system covers all the existing urban residents' health insurance and the new rural cooperative should be insured (co-operation), continue to implement the individual contributions and government subsidies combined with the main financing method, encourage collectives, units or other social and economic organizations to give support or funding. In addition, it is necessary to unify the protection treatment, including the starting standard, reimbursement ratio and maximum payment limit, etc., and the payment ratio of hospitalization expenses within the policy scope is maintained at about 75%.
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What are the reimbursement rates for health insurance?
I. Urban medical insurance reimbursement ratio. If an urban resident is hospitalized more than twice in a billing year, the starting standard fee will no longer be charged from the second hospitalization. If they are transferred to another hospital or hospitalized for more than two times, the difference will be made up in accordance with the starting standard of the hospital to which they are transferred or re-admitted.
1. Students and children. For medical expenses under 180,000 RMB incurred within a billing year that are eligible for reimbursement, the starting standard for Level III hospitals is 650 RMB, with a reimbursement rate of 50% and an upper limit of 2,000 RMB; the starting standard for Level II hospitals is 300 RMB, with a reimbursement rate of 60%; and Level I hospitals do not have a starting standard, with a reimbursement rate of 65%.
2. Aged 70 and above. For medical expenses under 100,000 RMB incurred within one billing year that are eligible for reimbursement, the starting standard for Level III hospitals is 650 RMB, with a reimbursement rate of 50% and an upper limit of 2,000 RMB; the starting standard for Level II hospitals is 300 RMB, with a reimbursement rate of 60%; and Level I hospitals do not set a starting standard, with a reimbursement rate of 65%.
3. Other urban residents. In a settlement year, incurred in line with the scope of reimbursement of `100,000 yuan or less of medical expenses, tertiary hospitals starting standard of 659 yuan, reimbursement rate of 50% of the upper limit of 2,000 yuan; secondary hospital hospitals hospitalization starting standard of 300 yuan, reimbursement rate of 55%; first-class hospitals do not set a standard of reimbursement, reimbursement rate of 60%.
Second, the employee health insurance reimbursement rate. Generally speaking, the economic development of different regions is different, so the reimbursement rate is also different, the following on the situation of the proportion of Beijing employee health insurance insurance is explained.
After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses of more than 1800 yuan after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, the reimbursement rate is 80 percent for expenses over $1,300.
And regardless of the type of person, the maximum limit for expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and spend $2,500 on an outpatient visit, then 50 percent of the $700 portion is reimbursed, which is $350.
In the case of hospitalization expenses, the starting amount is $1,300 for the first time you use basic medical insurance to pay in a 2009 year, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is determined at 50%, which is 650 yuan. And the maximum payment amount of the basic medical insurance fund (hospitalization expenses) is 70,000 yuan in 1 year.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person stays, such as staying in a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, that is, 85% reimbursement; from 30,000 yuan to 40,000 yuan, the employee pays 10%, and 90% reimbursement; more than 40,000 yuan to the part of the maximum payment limit, it is 95% reimbursement, and the employee only has to pay 5%. And retirees pay 60 percent of what active (that is, the aforementioned) employees pay individually, but anything below the starting level is paid by the individual.
The diagnostic and therapeutic items that are not covered by the basic medical insurance for employees are mainly those that are not clinically necessary, those whose effects are uncertain, and those for special medical services, including services such as registration fees, non-disease treatment items such as beauty treatments, therapeutic equipment and medical materials such as hearing aids, and therapeutic items such as magnetic therapy, as well as others such as infertility treatments, and so on.