Reimbursement in different hospitals varies greatly. Some hospitals have a large proportion of reimbursement, and some hospitals have a small proportion of reimbursement. Why? Is the proportion of medical insurance reimbursement related to the hospital level? What is the reimbursement rate of Zhoushan medical insurance? What are the application conditions for Zhoushan medical insurance reimbursement? I will answer the above questions for you one by one.
Zhoushan medical insurance reimbursement ratio
1. After the emergency treatment in the hospital, the medical expenses above 1800 yuan can be reimbursed, and the reimbursement rate is 50%;
2. If it is a retiree under 70 years old,1.The expenses above 300 yuan can be reimbursed, and the reimbursement rate is 70%;
3. For retirees over 70 years old,1.80% of the expenses above 300 yuan can be reimbursed.
Note: No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20,000 yuan.
4. In case of hospitalization expenses, employees and retirees should pay the minimum amount when using the basic medical insurance for the first time in a year 1300 yuan.
5, the second and later hospitalization medical expenses, Qifubiaozhun determined by 50%, for 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.
The proportion and standard of Zhoushan medical insurance reimbursement are related to the hospital level (taking the third-class first-class hospital as an example)
1, from qifubiaozhun to 30,000 yuan, the employee pays 15%, which means 85% reimbursement;
2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;
3. 95% of the part exceeding the maximum payment limit of 40,000 yuan can be reimbursed, as long as the employee pays 5%;
4. Retirees pay 60% of the employees.
Zhoushan medical insurance reimbursement application conditions
1. The applicant has gone through the insurance formalities and paid the medical insurance premium in full.
2, cooperative medical designated medical institutions for medical treatment;
3. The medical expenses incurred by the insured in hospitalization in medical institutions shall be paid in cash in advance, and relevant documents and materials shall be kept.
Zhoushan medical insurance application materials
1, original receipt;
2, hospitalization expenses statement;
3, discharge diagnosis certificate;
4. Copy of observation certificate or death certificate;
5, drugs, examination and treatment costs, emergency observation need to be stamped with the "emergency chapter" of the medical insurance prescription or emergency prescription of the emergency department;
6, social security card, "urban medical insurance manual";
7, the hospital full checkout certificate and unit description.
Zhoushan medical insurance handling process
1. The agent submits the reimbursement documents and other materials to the Dark Grey Insurance Fund Administration for acceptance;
2. After receiving the application materials, the accepting department will complete the examination, settlement and payment on the same day;
3, the social insurance fund management bureau to review the materials and approve the application, the applicant to receive the "social medical insurance medical expenses reimbursement form", be reimbursed.
Note: If the application materials are incomplete and all contents need to be corrected, the applicant shall correct the materials within 5 days from the date of receiving the Notice of Corrected Materials. If no correction is made within the time limit, the application shall be deemed to have been withdrawn. However, after the materials are corrected, the applicant may reapply within the statutory validity period. The applicant shall be reimbursed after receiving the Social Medical Insurance Medical Expense Reimbursement Form.