According to the relevant provisions of the medical social insurance system for urban and rural residents, the medical commercial insurance for urban and rural residents adopts the current policy of paying one year and enjoying one year, and adopts various forms of state subsidies and individual contributions. In 20021year, the national unified individual payment standard was 280 yuan and the state subsidized 550 yuan, both of which were promoted to 30 yuan and accumulated to 830 yuan on the premise of the previous year. Among them, 30 yuan, which has increased in China, is the key to apply for medical insurance for serious illness of urban and rural residents.
For social medical insurance, it is usually to deal with the insured's minor problems, or daily dizziness and other diseases. As long as you get sick and go to the designated hospital of the local medical insurance department, there is a professional medical insurance settlement dialog box. After the patient is hospitalized, he shall go through the hospitalization formalities with his social security card or identity certificate. After paying a certain entry threshold fee, you can help, using real-time settlement and reimbursement. The proportion of medical insurance reimbursement in general township hospitals is very high, reaching 90%. The lowest proportion of medical insurance reimbursement is tertiary hospitals, 50%, and the average proportion of comprehensive medical insurance reimbursement can reach 70%.
After the patient is hospitalized, he only needs to participate in medical insurance, and the system software will prompt the phenomenon of participating in medical insurance. The daily hospital settlement platform is connected with the accounting and payment operating system of the medical insurance bureau, which can monitor the outpatient expenses and medication of the system in real time. Therefore, after the patient is discharged from the hospital, he only needs to pay a part of his own self-payment, which belongs to the part of medical insurance reimbursement. The patient has been reimbursed through the hospital settlement system software network, and will no longer be reimbursed independently by the patient with relevant medical materials.
If it is a serious illness, when the out-of-pocket ratio reaches a certain amount, the hospital settlement platform will run the expense reimbursement of the critical illness medical insurance, which is the second expense reimbursement we mentioned before. This second reimbursement requirement is not uniform throughout the country. Generally, the per capita consumption expenditure of local residents is the standard. If the out-of-pocket amount exceeds the per capita income level of local residents' living environment, they will generally be reimbursed twice. The second expense reimbursement mainly refers to serious diseases, such as cancer patients and some diseases with high medical expenses. The first expense reimbursement and the second expense reimbursement are basically medical expenses and medical insurance reimbursement for serious diseases. All the patients' families don't have to run around after recovery, and they go to the hospital for medical insurance reimbursement everywhere.
Generally speaking, whether it is the former new rural cooperative medical system or the current medical commercial insurance for urban and rural residents, the expenses after hospitalization are reimbursed according to the real-time settlement system of designated hospitals. It can also be seen that the outpatient department of the hospital settles the hospitalization expenses with the medical insurance department in the form of advance payment. It is not necessary for patients to run around for reimbursement procedures after discharge, and the enterprise only pays part of the money.