1. Hospitals: with the Medical Insurance Certificate, IC card and admission card → hospitalization procedures (payment of hospitalization advance) → hospitalization → discharge procedures → settlement → only the individual part of the medical costs.
2. Local designated hospitals announced by the Social Security Office: present the Medical Insurance Certificate, unit certificate, IC card and admission card → apply for hospitalization (pay the hospitalization advance payment) → hospitalization treatment → go through the discharge procedure → make a copy of the relevant reimbursement information → settle the bill → pay the full amount of the medical expenses in advance.
When you are discharged from the hospital, you need to prepare all the reimbursement documents: the first copy of the unified medical receipt (original) as stipulated by the local province or city, the list of expenses, the discharge certificate (original), a copy of the objective medical record, the emergency medical record (emergency rescue), and the unit's certificate, which will be attached to the medical certificate and card when you make the reimbursement.
3, the Bureau of non-coordinated area of the original railroad hospital: medical procedures and local designated hospitals are the same, but reimbursement is still enjoying the relevant treatment. \u0013
Second, what is the cost reimbursement method?
Hospitals within the integrated area: no further reimbursement is required, and reimbursement has been made through the network at the time of discharge settlement. Local designated hospitals and other former railroad hospitals within the bureau's control: the relevant reimbursement information will be handed over to the unit to the Social Security Office (Chongqing, Guiyang Department of Medical Insurance) for review and reimbursement in accordance with the provisions of the reimbursement amount by wire transfer to the unit, the unit to notify the person to receive cash.
Question 2: How to reimburse the hospital with medical insurance Gynecological diseases require hospitalization for surgical treatment, belonging to the scope of the basic medical co-ordination, can be hospitalized in the hospital insurance designated hospital.
The real time you are hospitalized, with the health insurance card in the designated hospitals in the unified health insurance system to read the card, for hospitalization number, the hospital daily to the hospital number you enter your actual costs (by a unified standard, by the computer directly classified as out-of-pocket, Category A, Category B, etc.), to the time of discharge, by the health insurance system in accordance with a unified standard calculations, directly to the part of the should be paid by the health insurance co-ordination is not charged to you! -That's hospitalization reimbursement. You don't need to worry too much, just pay attention to the hospital to give you the use of Class B or self-financed drugs or diagnostic and therapeutic programs, should be informed in advance, and even should you sign the consent to use.
If specifically how much reimbursement - with a lot of factors:
1---- must be hospitalized in the health insurance designated hospitals can be;
< p> 2---- employees, retirees hospitalized, outpatient emergency rescue, medical costs above the starting standard of the integrated fund, the maximum payment limit below the part of the integrated fund will be paid by the integrated fund in accordance with the following proportions, the employees, retirees also have to bear a certain proportion of personalThe first-level medical institutions co-ordinated fund to pay 88% of the speculative 90.4% of retirees), the individual out-of-pocket payment of 12% (9.6% of retirees);
The second-level medical institutions co-ordinated fund to pay 85% (88% of retirees), the individual out-of-pocket payment of 15% (12% of retirees);
The third-level medical institutions co-ordinated fund to pay 82% (85.6% of retirees), the individual out-of-pocket payment of 82% (9.6% of retirees). 85.6% of the retirees), the individual out-of-pocket payment of 18% (14.4% of retirees).
3 ---- The starting standard of the integrated fund is usually referred to as the "threshold", which is the amount of medical expenses that must be borne by the individual before payment by the integrated fund, according to the regulations. The first thing you need to do is to get your hands on a new one, and then you'll be able to get your hands on a new one.
The starting standard of Wuhan's integrated fund is determined according to the different levels of medical institutions: 400 yuan for first-level medical institutions, 600 yuan for second-level medical institutions, and 800 yuan for third-level medical institutions.
4---- talked about above do not include out-of-pocket expenses.
Medical insurance hospitalization, in addition to the payment of medical insurance card, but also to pay the advance payment, local hospitals at all levels of requirements are different, about one thousand, insufficient hospitals will be at any time to call the money.
Question 3: How to reimburse hospitalization costs Sickness hospitalization belongs to the scope of the disease medical care, does not belong to the life of the accident insurance liability, not pay;
The new rural cooperative belongs to the rural villagers enrolled in the basic medical insurance, urban residents medical insurance is limited to urban residents for, it is not clear how you are not only enrolled in the new rural cooperative enrolled in the town of the resident health insurance, although there are The actual situation, but this is not able to apply for reimbursement in the two reimbursement departments, because you in the new rural reimbursement, the original invoice to be retained in the agricultural cooperation office, or although the original invoice nail but the invoice on the amount of reimbursement of the agricultural cooperation, the urban residents of medical insurance because there is no original invoice or invoice on the reimbursement of the agricultural cooperation has been reimbursed, the urban health insurance will not be reimbursed.
It is a great pity that the remaining two insurance policies can not be reimbursed, and there is no point in spending effort to prepare the materials. It is recommended that the next time the reimbursement is made, the first thing to do is to understand the reimbursement rate of the local agricultural and urban medical insurance, and then choose the insurance with the higher reimbursement rate to apply for reimbursement.
Question 4: Hospitalization insurance reimbursement? How to report Hello, I hope my answer can help you.
First of all, you need to understand: the money in the medical insurance card is also your money.
The first thing you need to understand is that the money in your card is your money too. When you are hospitalized, there is a threshold, which is as follows:
You will not be reimbursed if you spend less than 700 RMB. Spending 700.01 to 10000, the maximum reimbursement base is 3077.38 yuan, the reimbursement rate is 85%. That is, the health insurance reimbursement of 2615.77 yuan, personal out-of-pocket 461.61 yuan.
If you spend $800 on hospitalization, reimbursement = (800-700)*85% = $85.
Spent $4000, same thing = (4000-700)*85%=2805, but the maximum reimbursement under the health insurance is $2615.77, so you can only reimburse $2,615.77, see? I am a corporate health insurance, spent 3970 yuan, can only be reimbursed 2615.77 yuan, the rest of their own burden!
When you get to the hospital, tell him "I'm on Medicare" and give him your card. The first thing you need to do is to get the money to pay for it. The first thing you need to do is to get the money back when you are discharged from the hospital.
Should that make sense? I wish you a speedy recovery and don't get angry! Health is the greatest asset.
Question 5: How do I get reimbursed for my hospitalization?
The two medical insurance can be reimbursed, I in the "insurance harbor" website excerpts of some information for your reference:
Township residents of the basic medical insurance reimbursement in two ways:
First, the network settlement. The insured person in the hospitalization network has been implemented in the settlement or the settlement of the designated medical institutions, in the designated hospital fee window only need to pay the personal payable part of the cost, the rest of the cost by the social security center in accordance with the provisions of the settlement with the designated medical institutions.
Second, the full advance reimbursement. Participants in the medical institutions have not yet implemented network settlement of hospitalized medical costs, first by the individual advance, after discharge, with the designated hospital discharge certificate, medical fee invoices and full list of costs, to the town labor security service center and its community labor security workstations to register, collect reimbursement information, unified to the social insurance agency to review and settle. The social insurance agency will complete the settlement within the stipulated time and pay the reimbursed medical expenses according to the regulations.
The basic medical insurance reimbursement procedure for urban residents
After the insured patients are discharged, they need to submit ① a copy of the first page of the medical record (to be stamped by the medical insurance department of the hospital), ② a summary of the discharge, ③ a receipt of hospitalization expenses, ④ a detailed breakdown of hospitalization expenses (one-day list), ⑤ a copy of the cash payment list of the medical insurance, ⑥ a certificate of discharge, ⑦ a copy of the ID card to the community, and the relevant registrations.
By the 5th day of each month, each community will submit the relevant materials and forms to the district health insurance office.
From the 5th to the 10th of each month, the district health insurance office will review the relevant bills and calculate the amount of reimbursement.
On the 12th-15th of each month, the report will be submitted to the Municipal Medical Insurance Center for approval.
In the first half of the following month, the reimbursement will be paid. The insured patients need to bring their ID cards to the district health insurance office to receive.
In Chongqing, for example, according to the latest reimbursement rate adjustment in Chongqing in 2008, the public if you choose to participate in the second class, that is, the cost of participation in the 200 yuan individual payment of 60 yuan | year | person, its medical expenses will be adjusted on the basis of the original proportion of 10% of the insured municipal stands per person per year, the maximum amount of reimbursement for the medical expenses of 60,000 yuan; choose to participate in the first class of the citizens, its medical reimbursement according to the local new rural cooperative The reimbursement standard implementation, the annual reimbursement ceiling from the original more than 10,000 yuan to more than 30,000 yuan.
The urban and rural cooperative medical insurance is divided into a starting line and a ceiling line, the starting line is determined by the level of the hospital, the minimum is 200 yuan, the maximum is 1,000 yuan, the medical expenses paid by the residents to see a doctor under the starting line, the insured residents to bear their own.
On the reimbursement of commercial insurance you can get according to your contract, it is recommended that you go to the "insurance port" website to view the relevant information, a good understanding of the insurance reimbursement, so as to avoid disputes in the future
The insurance port - a professional
Question 6: How do you get reimbursed for hospitalization on your health insurance card? Medical insurance reimbursement needs to go to the local medical management center or designated medical institutions medical insurance checkout window reimbursement.
The information includes my ID card, the original invoice of the health insurance card famine, the list of medication, medical records and other materials.
It is very convenient to be reimbursed at the checkout window when you are discharged from the hospital.
The rate of reimbursement varies from region to region. You just need to prepare the above information to go to the reimbursement when the staff will naturally give you the calculation.
Question 7: How do I get reimbursed for hospitalization? Hospitalization registration: the insured person is sick and really need to be hospitalized, the doctor issued a hospitalization order, by the designated medical institution medical insurance management department review and approval before hospitalization; emergency patients can be admitted to hospital, within three working days to make up for the approval procedures.
Hospitalization deposit: When a participant is hospitalized in a designated medical institution, the hospital may charge a certain amount of deposit according to the different types of diseases, but not more than the individual's share of the deposit. The deposit will be refunded when the patient is discharged from the hospital.
Hospital responsibility: during the hospitalization of the insured person, the designated medical institution must provide the patient with a detailed list of costs. The use of Class B drugs and the individual part of the cost of diagnosis and treatment programs should be informed of the patient in advance. The bed charge is over the standard, and the costs outside the "three catalogs" should be agreed with the participant.
Discharge settlement: When a participant is discharged from the hospital, he or she should settle the individual out-of-pocket payment with the designated medical institution in a timely manner. The designated medical institution should print the receipt and settlement list.
Discharged with medication: Participants are generally not allowed to take medication with them when they are discharged from the hospital after recovering from illness. If it is necessary to bring medicine, the designated medical institution should strictly control, generally not more than seven days.
Referral and transfer
1, the city referral and transfer: has been admitted to the hospital, the hospital due to equipment or technical limitations of the diagnosis and treatment of the difficulties, in accordance with the provisions of the patient for transfer. When a participant is transferred to a higher level hospital, he should make up the difference in the starting payment standard of the hospital to which he is transferred. After the end of the medical treatment, the costs of the transferred hospital and the transferred hospital, combined as a hospitalization cost settlement.
2. Off-site referral and transfer: If the conditions for referral and transfer to a hospital are met, a specialist hospital above the municipal level can conduct expert consultation by a Level 3A designated medical institution and make recommendations. The hospital's medical insurance management department will fill in the Jinan Urban Workers' Medical Insurance Referral and Transfer Record Form and report it to the relevant medical insurance agency for approval.
The conditions for referral to a different hospital should be:
① the city is limited to technical and equipment conditions can not be treated for critical and difficult diseases;
② by the city of the three A-class designated medical institutions or municipal hospitals above the examination of specialist hospitals, expert consultation is still not diagnosed;
③ the receiving hospital's level of diagnosis and treatment is higher than the level of the city.
If a participant really needs to be referred to a hospital for treatment, he or she should be examined and approved by a designated general hospital of the third class or a designated specialized hospital at or above the municipal level in his or her city, and then fill in the "Jinan Urban Employees' Health Insurance Participant Referral and Transfer Form for the Record" and submit it to his or her health insurance agency for record, and then sign the form for the record after verifying that his or her condition really needs to be referred to.
How to reimburse the hospitalization? Several special cases of participants in the medical procedures:
1, relocation: relocation of participants should be hospitalized in the record of designated hospitals, designated hospitals change after the insured unit should be promptly to the affiliated health insurance agency for change procedures.
2, long stay abroad: long stay abroad participants should be hospitalized in the designated hospital for the record, the designated hospital changes in the participating units should be timely to the affiliated health insurance agency for change procedures; participants back to the local work should also be timely for the change of identity procedures.
3. Leave of absence: When a participant is hospitalized during leave of absence, he/she must report to his/her unit within three working days after admission to the hospital, and the staff of his/her unit should immediately go to his/her health insurance agency to complete the registration formalities.
4. Non-designated emergency hospitalization: When a participant is hospitalized in a non-designated hospital in the city due to a critical condition, he or she shall be registered at his or her health insurance agency within three days from the date of hospitalization by his or her unit's operator with the outpatient resuscitation medical record, a copy of the examination and test report, and the diagnostic certificate issued by the doctor who treated him or her. No valid reason for late reporting or verification is not a critical patient emergency rescue, the integrated fund will not be paid, the condition allows, should be transferred to a designated medical institution for treatment.
5, the gray list of participants hospitalized: the unit owes the fee after the participant is admitted to the hospital, the card system automatically determine the gray list. In this state, the designated medical institution should still implement the basic medical insurance policy for the participant, and the medical information is also uploaded to the core terminal, but when discharged from the hospital, the medical expenses are completely borne by the individual.
If the payment status is normal when you are admitted to the hospital, but the card system judges you as gray list when you are discharged from the hospital, the settlement procedure is the same as above.
In addition: (1) the participant was admitted to the hospital without a card
The participant was admitted to the hospital without a card, should promptly apply for loss and replacement of the card, and go to the audit and settlement of a registration, one to give the relevant certificate, the participant should be given the certificate to the hospital hospital health insurance management department in a timely manner, the health insurance management department should notify the doctor in charge of its staff to implement basic medical insurance policy on the participant in the hospital period. medical insurance policy during hospitalization. After replacing the card, then do the hospitalization re-registration in the hospital where you live.
⑵ Participants discharged from the hospital without a card
Participants discharged without a card, the hospital should let the participant advance payment of the hospitalization ...... >>
Question 8: How to reimburse the second hospitalization expenses where to reimburse the second subsidy, please enjoy the second subsidy person's own second-generation resident ID card, my city bank card or passbook (except for the Farmers and Merchants Bank account number) of the original and photocopies; if not in person to deal with the original and photocopies of the second-generation resident ID of the person who also need to provide the agent to the city social security center. The first step in the process is to make sure that you have the right to get the best out of the program.
"Second reimbursement" is the urban residents of the medical insurance or new rural cooperative residents, if the last year to see the doctor has a high cost, in addition to the normal reimbursement, but also can be reported once again to the major medical insurance, and does not set a ceiling line.
The second reimbursement of medical insurance refers to the basic medical insurance reimbursement, by the retirees, military disability benefits and other funds will need to be part of the amount of personal out-of-pocket payments in accordance with the corresponding proportion of the reimbursement once again. The first thing you need to do is to get your hands on a new one, and you'll be able to do it in a few minutes. That is to say, within a year for the hospitalization settlement procedures for hospitalization costs (including family hospital beds and out-of-town medical treatment), the annual cumulative personal out-of-pocket part of the minus C costs in the part of 10,000 yuan or more can enjoy the second subsidy of the medical insurance fund.
Medical insurance secondary reimbursement process:
First, outpatient, emergency reimbursement
Large medical mutual aid (outpatient, emergency) starting line amount of in-service employees for 2000 yuan, retirees for 1300 yuan. If the accumulated outpatient and emergency expenses in a year are less than 2,000 yuan for employees and 1,300 yuan for retirees, the participants will pay from their individual accounts. If the amount above the starting line is reached in a natural year, the system of large medical mutual aid can be applied
Second, the reimbursement of hospitalization expenses
According to the regulations, at present, when the first time to use the basic medical insurance to pay for the hospitalization expenses in a year, the amount of the starting line of the working and retired people are 1300 yuan. For the second and subsequent hospitalization medical expenses, the starting standard is determined at 50% and is 650 RMB. The maximum payment from the Basic Medical Insurance Co-ordination Fund (for hospitalization expenses) is currently 70,000 RMB in one year. The individual payment rate for retirees is 60% of the individual payment rate for active employees, but the same portion below the starting standard is all paid by the individual. The hospitalization reimbursement rate is related to the level of the medical institution where the participant is admitted.
Note: There are two thresholds for outpatient and hospitalization.
Third, what is the amount of reimbursement for hospitalization expenses exceeding the maximum payment limit?
If a participant's hospitalization cost is more than the maximum payment limit, the excess cost will be reimbursed according to the relevant standards of the Large Medical Mutual Aid, i.e., 70% will be paid by the Large Medical Mutual Aid Fund and 30% will be paid by the individual. Within one year, the cumulative maximum payment amount of the large medical mutual aid is 100,000 yuan.
Question 9: How is the hospitalization fee reimbursed by the New Farmers' Cooperative? What can be reported, which can not be reported, the province has detailed regulations, in the provisions of the book of clear can be reimbursed only to report. General checkups and general surgical fees are all counted as reimbursable expenses. Health material costs are generally segmented policy, such as 30 below the full reimbursable, more than 30 6666 75% of the following counted in the reimbursable, 6666 above the single cap 5000 counted in the reimbursable, the policy may be different from province to province. The bed fee is capped by day and by level, and may be up to $15 per day (different levels vary). Drugs are based on the provincial catalog. Add up all the reimbursable expenses, minus the starting line, and multiply by the percentage, which is basically the reimbursement cost. Generally this manual calculation can not, are computerized automatic judgment.