Today I will tell you how to use the medical insurance card!
1. What's the difference between the two accounts of the medical insurance card?
There are two accounts for employee medical insurance: pooling account and individual account, with different payment ranges. Personal account is mainly used to pay for general outpatient service, and overall account is mainly used to pay for hospitalization and outpatient treatment of chronic diseases.
(Note: The proportion of payment varies from place to place)
Personal accounts can pay the following fees
Outpatient and emergency medical expenses;
The cost of purchasing drugs at designated retail pharmacies;
Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund;
Medical expenses that exceed the qifubiaozhun of the basic medical insurance pooling fund and should be borne by individuals in proportion.
The overall account mainly pays the following fees
Hospitalization medical expenses;
Emergency rescue observation and income hospitalization, medical expenses within 7 days before hospitalization observation;
Outpatient medical expenses of taking anti-rejection drugs after radiotherapy and chemotherapy, renal dialysis and renal transplantation for malignant tumors.
Second, how to reimburse the medical insurance card?
Medical insurance card in hand, worry-free medical treatment?
Too young and too simple!
Medical insurance reimbursement routines are notoriously deep.
(Note: The proportion of medical insurance reimbursement varies across the country. Generally speaking, the better the hospital, the lower the reimbursement rate. )
Payment line
Refers to the expenses below the minimum deductible, also called absolute deductible, which shall be borne by yourself.
Upper limit of reimbursement
According to the medical insurance policy, the medical expenses below the upper limit are reimbursed, and the above expenses are not covered by medical insurance.
Self-funded part
Refers to some imported drugs, specific drugs, medical devices and medical services that are not reimbursed by medical insurance. You pay for this part yourself.
Three, two kinds of medical insurance reimbursement.
See the clinic
Look at the money from the outpatient clinic to buy medicine and brush personal accounts. If it is brushed up, or the medicine bought is not within the scope of reimbursement, you can only pay for it yourself.
take for example
Xiao Wu spent 8,000 yuan a year in a designated 3A hospital, and paid for 600 yuan at his own expense. The reimbursement rate and maximum limit of local medical insurance outpatient service are as follows.
Then, the expenses reimbursed by Xiao Wucan = (8000-1800-600) × 70% = 3920 yuan.
be hospitalized
Hospitalization medical expenses are reimbursed by the overall account, which means "expenses within the scope of social security". If it is self-funded, self-funded, medical insurance cannot be reimbursed.
take for example
The cost of cardiac stent surgery in a tertiary hospital in Zhou Xiao is1.2000, including 90000 in-catalog expenses and 30000 out-of-catalog expenses. The reimbursement ratio and maximum amount of hospitalization expenses for local employees' medical insurance are as follows.
How much can Zhou Xiao's operation expenses be reimbursed? Let's calculate the overall reimbursement portion = (90,000-1300) × 95% = 84,265. If it does not exceed the maximum limit of 65,438+10,000 yuan, then Zhou Xiao can reimburse 84,265 yuan.
pay attention to
The reimbursement policies of medical insurance vary from place to place, and the payment standards, reimbursement ratios and reimbursement limits are also different. The specific reimbursement is subject to local official policies, and the above data are for reference only.
Fourthly, some skills to maximize medical insurance reimbursement.
1. See a doctor and prescribe medicine, and explain the needs in advance.
Tell the doctor that you need medical insurance, and ask the doctor to prescribe only drugs and tests within the scope of medical insurance.
2. You can refuse to pay without signature.
In some cities, it is stipulated in documents that the use of medical materials with a value of more than 600 yuan by medical institutions should be signed and agreed by the insured or their families. If they use them directly without consent, the insured can refuse to pay.
3. The reimbursement rate of primary medical institutions is higher.
Judging from the situation in most areas, hospitalization in primary medical institutions has a low deductible and a high reimbursement rate. So it is more cost-effective to go there for some common ailments.
4. It is more economical to transfer according to regulations.
Rural patients often encounter this kind of experience. After seeing a doctor in a county hospital, they are transferred to a provincial hospital for treatment, only to find that less can be reimbursed. Because there is no transfer according to the regulations, it is necessary to reduce the reimbursement ratio, raise the deductible line, and repeat.
Above, I just want to share some knowledge about medical insurance card with you, and I hope you can pay attention to it.