The Medical Insurance Department of Bozhou Human Resources and Social Security Bureau is mainly responsible for implementing the measures for the administration of national medical insurance and maternity insurance funds; Responsible for the management, examination and approval, supervision and inspection of settlement methods and payment scope of medical insurance services and maternity insurance services of designated medical institutions and pharmacies.
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First, how to reimburse medical insurance
1. The medical insurance is divided into two accounts, the personal account, and the money reflected by the medical insurance card can be used to buy medicines at designated pharmacies, and the individual pays for outpatient expenses and hospitalization expenses; The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account.
2. When seeking medical treatment, show the medical insurance card to the designated hospital to prove the identity and registration of the insured. The part of medical insurance reimbursement is settled by medical insurance and hospitals, and individuals do not need to pay in advance before reimbursement. At the time of checkout, the part paid by the individual is paid by the balance of the medical insurance card and cash.
3. There is a deductible when reimbursement for hospitalization (the deductible standard is generally 10% of the average annual salary of employees in the city last year), which means that you need to pay the deductible yourself, and the part that exceeds the deductible can be reimbursed according to local medical insurance regulations. The reimbursement rate varies from place to place, and different hospitals and different projects are also different. I can't give it to you specifically, about 80%. You can go to the local area to learn more about it.
Second, the role of medical insurance card
1, personal social security related information records, electronic certificates and information inquiry, etc.
2. Record the insured's name, ID number, date of birth, gender, nationality, household registration and other basic information.
3, query my pension, unemployment, medical care, work injury and maternity insurance payment.
4. You can take the card to the hospital and go to the pharmacy to buy medicine.
5 for medical care, unemployment, pension, work injury, maternity and other social security affairs.
6. Query the accumulated amount of endowment insurance and medical insurance.
According to the provisions of the Social Security Law, those who defraud social insurance benefits by fraud, forgery of certification materials or other means shall be ordered by the social insurance administrative department to return the defrauded social insurance benefits, and a fine of not less than two times but not more than five times the amount defrauded shall be imposed. If a crime is constituted, criminal responsibility shall be investigated according to law.
Three, the scope of use of medical insurance card mainly has the following three aspects:
1, used to buy medicine: when the insured buys medicine at the designated pharmacy, they can pay with the medical insurance card.
2. Used for reimbursement: If you go to the hospital for medical treatment, whether it is outpatient or inpatient, you can use the medical insurance card for reimbursement if it reaches the medical insurance deductible line and is within the scope of medical insurance reimbursement.
3. Medical expenses: When the participants are sick, they can register with the designated hospital with the medical insurance card and medical insurance manual. The main process is as follows: holding the medical insurance manual and medical insurance card-registering with the hospital medical insurance office-reviewing the card-paying the hospitalization deposit-hospitalization-the patient agrees to the self-funded project and signs it-cash or medical insurance card.