I. Employee medical insurance benefits:
Qifubiaozhun for hospitalization: Grade III includes hospitals above Grade III: Qifubiaozhun for multiple hospitalizations in 700 yuan within one year is 500 yuan, 400 yuan and 300 yuan in turn.
Secondary hospitals include secondary specialized hospitals: 600 yuan was hospitalized several times in one year, followed by 400 yuan, 300 yuan and 200 yuan.
The first level includes the following hospitals: hospitalization in 500 yuan for many times within one year, and minimum compensation for 300 yuan and 200 yuan, 100 yuan.
Two, employee medical insurance payment ratio:
Above the deductible and below the maximum payment limit, 85% of class A and general medical expenses are paid by on-the-job employees.
Retiree payment: 90%. Class B drugs pay 75% and cutting-edge drugs pay 70%.
Three, employee medical insurance Qifubiaozhun:
Medical insurance for employees with chronic diseases, special diseases and major diseases, the annual Qifubiaozhun is 700 yuan. Class A and general diagnosis and treatment 80%, class B 75%, high accuracy 70%.
Maximum payment limit: 50,000 yuan (including hospitalization+outpatient chronic diseases+special diseases+major diseases)
It should be noted that the following items are no longer only within the reimbursement scope of medical insurance:
(1) service items. (1) Registration fee, out-of-hospital consultation fee, medical record fee, etc. (2) Special medical services, such as visiting fees, expedited fees for examination and treatment, additional fees for roll-call surgery, high-quality and low-price fees, and self-invited intensive care.
(2) Non-disease treatment projects. (1) all kinds of beauty and bodybuilding, as well as non-functional plastic surgery and orthopedic surgery; (2) all kinds of weight loss, weight gain and height increase projects. (3) various health checks; (4) all kinds of preventive health care and diagnosis projects; (5) all kinds of medical consultation and medical appraisal.
(3) Diagnostic equipment and medical materials. (1) Examination and treatment items of large medical equipment such as positron emission tomography (PET), electron beam cT and ophthalmic excimer laser therapeutic instrument; (2) glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation devices; (3) all kinds of self-use health care, massage, examination and treatment equipment; (4) The provincial price department stipulates that one-time medical treatment cannot be charged separately.
(4) Treatment items. (1) The organ source or tissue source of various organ or tissue transplants; (2) Transplantation of organs or tissues other than kidneys, heart valves, corneal skin, blood vessels, bones and bone marrow; (3) Orthopedic surgery for myopia; (4) Qigong therapy, music therapy, health nutrition therapy, magnetic therapy and other auxiliary treatment projects.
(5) others. (1) various infertility (pregnancy) and sexual dysfunction diagnosis and treatment projects; (2) all kinds of scientific research and clinical verification of diagnosis and treatment projects.
After the insured employees seek medical treatment, they can be reimbursed according to the following procedures:
First, hospitalized patients are hospitalized in designated medical institutions in the region.
Show your medical insurance card first, and then pay a certain threshold fee according to the level of the hospital. After discharge, you can enjoy medical insurance benefits at the hospital medical insurance settlement office.
Second, the reimbursement procedures for hospitalization in different places
(1) Reporting settlement data
Please bring the following information for reimbursement of hospitalization in different places.
1, hospital invoice (seal)
2. Detailed list of hospitalization expenses (seal)
3. Discharge record (seal)
4, the use of drugs outside the directory and special diagnosis and treatment project copy (seal)
5. Medical insurance card
6, complete procedures of "Wuhan caidian district urban workers medical insurance referral form".
(2) Settlement
The hospitalization procedures in different places are complete, and the reimbursement will be settled with the receipt and my ID card (the consignee needs to provide the consignee ID card) after 5 working days. Reimbursement will be suspended from 28th to the end of each month, and resumed the following month 1 day.
Third, the outpatient reimbursement procedures for critically ill patients
(1) reimbursement time
Reimbursement time of hypertension and diabetes in critical outpatient department: 1 quarter March; The second quarter is June; The third quarter is September; The fourth quarter is 65438+February.
The outpatient department of other diseases is reimbursed once a month.
(2) Reporting settlement data
1, outpatient medical receipt; 2, Chinese prescription unit price and seal; 3. Check the original attached inspection report.
(3) Settlement
After completing the formalities, the reimbursement amount will be directly transferred to my bank passbook after 5 working days.