A, urban and rural residents of the basic medical insurance card medical insurance card and social security card, what are the differences?
(a) the concept of different social security card referred to as the social security card, issued by the local human resources and social security departments for the community, for human resources and social security in various business areas of the integrated circuit card. The medical insurance card is a special card for the medical insurance personal account, with the personal ID card as the identification code, stored in the personal ID number, name, gender, and the account of the allocation of funds, consumption and other details of information. (2) Different functions The social security card not only has the function of medical insurance card, but also for the social security business is an important certificate, such as receiving unemployment benefits and so on. The medical insurance card is limited to the medical insurance function, can only be used to enjoy the medical insurance treatment. (C) card issuance place is different medical insurance card by the local designated agent bank contractors. The social security card is issued by the local human resources and social security departments for the community. (D) security performance is different social security card has adopted a unified three-tier key management system, its security, reliability has passed the national acceptance, can really make the social security card to become a participant in the "security card", "rest assured that the card", but also for the future realization of the cross-provincial social security card, the social security card is not the same, but the social security card is not the same. The card has also laid a good foundation for the future realization of national universalization across provinces. The medical insurance card does not have this management system, the safety factor is lower. (e) The social security card has a wider range of uses. The social security card will be widely used in human social security business, and can be used as a financial debit card. The medical card is only used as a voucher for medical insurance settlement. (F) security is different Social security card performance is more stable. Social security card due to the use of integrated circuit chips, than the use of magnetic stripe media medical insurance card performance is more stable, not easy to damage, and more secure.Two, the basic medical insurance reimbursement rate (a) rural
1, outpatient village health clinic and village center health clinic clinic reimbursement of 60% of each visit prescription drug fee limit of 10 yuan, the health center doctors temporary rehydration of the prescription drug fee limit of 50 yuan; the township health hospital clinic clinic reimbursement of 40% of each visit various checkups and surgical fees limit of 50 yuan, prescription drug fee limit of 100 yuan; secondary hospitals reimbursement of 30%, each visit checkups and surgical fees limit of 50 yuan, prescription drug fee limit of 200 yuan; tertiary hospitals reimbursement of 20%, each visit checkups and surgical fees limit of 50 yuan, prescription drug fee limit of 200 yuan; Chinese medicine invoices attached to the prescription of each sticker Limit of 1 yuan; town-level cooperative medical outpatient compensation annual limit of 5,000 yuan. 2, hospitalization reimbursement scope: medicine: auxiliary examination: EEG, X-ray, film, laboratory, physical therapy, acupuncture, CT, nuclear magnetic **** vibration and other examination fees limit of 200 yuan; surgical expenses (with reference to the national standard, more than 1,000 yuan reimbursement according to 1,000 yuan). 60 years old or older hospitalized in the hospital, the treatment costs and nursing care costs per day, reimbursement of 10 yuan, limit of 200 yuan. reimbursement of 10 yuan, a limit of 200 yuan. Reimbursement ratio: 60% for town health centers; 40% for secondary hospitals; 30% for tertiary hospitals. 3, the big disease Where to participate in the cooperative medical treatment of hospitalized patients with a one-time or annual cumulative reported medical expenses exceeding 5,000 yuan of segmented compensation, that is, 5,001-10,000 yuan compensation of 65%, 10,001-18,000 yuan compensation of 70%. The annual limit of 11,000 yuan for compensation for town-level cooperative medical care inpatient and outpatient blood dialysis for uremia, outpatient radiotherapy and chemotherapy for tumors. (2) Township residents Township residents hospitalized for more than two times in one billing year, from the second hospitalization, no longer charged the starting standard fee. If they are transferred to another hospital or hospitalized for more than two times, the difference will be made up in accordance with the prescribed starting standard for transferring to or re-admitting to the hospital. 1, students, children in a billing year, incurred in line with the scope of reimbursement of less than 180,000 yuan of medical expenses, the starting standard for tertiary hospitals 650 yuan, reimbursement rate of 50%, the upper limit of 2,000 yuan; secondary hospitals starting standard of 300 yuan, reimbursement rate of 60%; first-class hospitals do not have a starting standard, reimbursement rate of 65%. 2, 70 years old and above In a settlement year, the medical expenses of less than 100,000 yuan that meet the scope of reimbursement, the starting standard of third-level hospitals is 650 yuan, the reimbursement rate is 50%, and the upper limit is 2,000 yuan; the starting standard of second-level hospitals is 300 yuan, the reimbursement rate is 60%; and first-level hospitals don't have the starting standard, and the reimbursement rate is 65%. 3, other urban residents in a billing year, occurred in line with the scope of reimbursement of medical expenses of less than 100,000 yuan, the starting standard for third-level hospitals 659 yuan, reimbursement rate of 50% ceiling of 2,000 yuan; hospitalization of second-level hospitals starting standard of 300 yuan, reimbursement rate of 55%; first-class hospitals do not have a starting standard, reimbursement rate of 60%. (C) employees Generally speaking, the economic development of different regions is different, so the reimbursement rate also varies, the following on the Beijing employee health insurance insurance ratio situation is explained. After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses above 1800 RMB after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50%. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. If the retiree is over 70 years old, expenses over $1300 can be reimbursed the reimbursement rate is 80%. And regardless of the category, the maximum amount of expenses paid for outpatient and emergency major medical expenses is 20,000 yuan. For example, if you are an active employee and the cost of an outpatient visit is $2,500, then 50% of the $700 portion can be reimbursed, which is $350. In the case of hospitalization expenses, the starting amount is $1,300 for the first time you use basic medical insurance to pay in a year in 2009, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is determined by 50%, which is 650 RMB. And the maximum payment amount of the basic medical insurance fund (hospitalization expenses) is 70,000 yuan in 1 year. The standard of hospitalization reimbursement is related to the level of the hospital in which the insured person lives, such as living in a tertiary hospital, from the starting standard to 30,000 yuan of expenses, the employee pays 15%, that is, 85% reimbursement; 30,000 yuan to 40,000 yuan of expenses, the employee pays 10%, reimbursement of 90%; more than 40,000 yuan to the highest limit of the payment of the portion of the cost, then 95% of the cost of reimbursement, the employee only has to pay 5%. The proportion of retiree personal payment is 60% of the active (that is, the above-mentioned) employees, but the starting standard below, are paid by the individual. The basic medical insurance for employees will not pay for the cost of diagnostic and treatment programs are mainly non-clinically necessary, the effect of uncertain diagnostic and treatment programs as well as special medical services diagnostic and treatment programs, including services such as registration fees, non-disease treatment programs such as cosmetology, therapeutic equipment and medical materials such as hearing aids and other therapeutic programs such as magnetic therapy and other categories such as infertility treatments. In accordance with the "National Basic Medical Insurance Treatment Program Scope", the details are as follows: 1, the service category. (1) registration fees, out-of-hospital consultation fees, medical records, etc.; (2) visit fees, examination and treatment of expedited fees, named surgery surcharge, quality premiums, self-requested special nurses and other special medical services. 2, non-disease treatment program category. (1) a variety of beauty, fitness and non-functional cosmetic, orthopedic surgery; (2) a variety of weight loss, weight gain, height projects; (3) a variety of health checks; (4) a variety of preventive, health care diagnostic and treatment programs; (5) a variety of medical consultations, medical appraisal. 3, diagnostic equipment and medical materials. (1) the application of positron emission tomography device (PET), electron beam cT, ophthalmic excimer laser therapy instrument and other large medical equipment for examination and treatment programs; (2) glasses, dentures, prosthetic eyes, artificial limbs, hearing aids and other rehabilitative devices; (3) a variety of health care for their own use, massage, inspection and treatment equipment; (4) the provincial price departments can not be charged separately for disposable medical. 4, treatment program category. (1) all types of organ or tissue transplantation of organ source or tissue source; (2) in addition to kidney, heart valves, cornea skin, blood vessels, bone, bone marrow transplantation outside of other organs or tissues transplantation; (3) myopic orthopedics; (4) qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other complementary therapeutic projects. 5, other. (1) a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; (2) a variety of scientific research, clinical verification of the diagnosis and treatment program.Three, medical insurance reimbursement scope health insurance scope is very wide, medical costs are generally in accordance with the characteristics of its medical services to distinguish, mainly contains the doctor's outpatient costs, medicine, hospitalization costs, nursing costs, hospital miscellaneous expenses, surgical costs, various inspection costs. Medical expenses are the costs incurred by the patient for the treatment of the disease, which includes not only the doctor's medical and surgical fees, but also the costs of hospitalization, nursing care, hospital equipment and so on.
Medical insurance reimbursement rate and scope: 1, outpatient, emergency medical expenses: in the year of the active employees (January 1 ~ December 31) in line with the provisions of the basic medical insurance coverage of the accumulated medical expenses more than 2,000 yuan above the part. 2. Settlement ratio: 50% reimbursement for the part above 2000 RMB for the dispatched personnel during the contract period, and 50% out-of-pocket payment by the individual; the maximum amount of reimbursement for the dispatched personnel for outpatient and emergency services is 20,000 RMB in a year. 3, the insured person should properly keep the outpatient medical bills in the designated hospitals (including receipts, prescription bottoms, etc.), as a medical expense reimbursement voucher. 4, three kinds of special disease outpatient medical care: participants suffering from malignant tumors radiation therapy and chemotherapy, renal dialysis, kidney transplantation to take anti-rejection drugs need to be in outpatient medical care, by the participant to the second and third-class designated hospitals to issue a "diagnosis of the disease certificate" and fill out the "medical insurance special disease declaration and approval form", reported to the district medical insurance center for approval and filing. Center for approval and filing. Outpatient medical treatment and medicine collection for these three special diseases are limited to the approved designated hospitals, and cannot be purchased at designated retail pharmacies. The medical expenses incurred are in accordance with the scope of outpatient special diseases, with reference to the hospitalization for settlement. 5. For inpatient medical care, the medical insurance payment is enough for 20 years in order to enjoy the medical insurance reimbursement after retirement. Rural cooperative medical insurance reimbursement rate and scope: 1, outpatient reimbursement: (1) 60% reimbursement for village health clinics and village center health clinics, with a limit of 10 yuan per visit for prescription drugs, and a limit of 50 yuan for temporary rehydration of prescription drugs by doctors in health centers. (2) Township health centers are reimbursed 40% of the cost for each visit, with a limit of 50 yuan for each examination and surgery, and a limit of 100 yuan for prescription drugs. (3) 30% reimbursement for visits to secondary hospitals, with a limit of RMB 50 per visit for examinations and surgeries, and RMB 200 per visit for prescription drugs. (4) Tertiary hospitals will reimburse 20% of the cost, with a limit of RMB 50 per visit for tests and procedures and RMB 200 for prescription drugs. (5) Chinese medicine invoices attached to the prescription limit of 1 yuan per sticker. (6) Township-level cooperative medical outpatient compensation is limited to 5,000 yuan per year. 2, hospitalization compensation (1) reimbursement scope: A, medicine: auxiliary examination: EKG, X-ray fluoroscopy, filming, laboratory tests, physiotherapy, acupuncture, CT, nuclear magnetic **** vibration and other inspection fees limit of 200 yuan; surgical fees (with reference to the national standard, more than 1,000 yuan reimbursement according to 1,000 yuan). B, the elderly over 60 years of age hospitalized in Xingta Town Health Center, treatment and care costs are compensated 10 yuan per day, limit 200 yuan. (2) reimbursement ratio: town health center reimbursement 60%; secondary hospital reimbursement 40%; **** hospital reimbursement 30%. 3, compensation for major illnesses (1) town risk fund compensation: all participating in the cooperative medical treatment of hospitalized patients with a one-time or annual cumulative reportable medical expenses exceeding 5,000 yuan above the sectional compensation, i.e., 5,001-10,000 yuan compensation of 65%, 10,001-18,000 yuan compensation of 70%. The annual limit of compensation for town-level cooperative medical care inpatient and uremia outpatient hemodialysis, oncology outpatient radiotherapy and chemotherapy is 11,000 yuan. Rural cooperative medical insurance is not reimbursed: 1, self-medication (not designated hospitals for medical treatment or do not handle the referral order), self-purchase of drugs, public medical provisions can not be reimbursed for drugs and medical expenses not in line with the family planning; 2, outpatient treatment costs, clinic fees, hospitalization fees, meals, accompanying guests, nutritional costs, blood transfusion costs (except for those who have a family blood storage, reimbursement in accordance with relevant regulations 3, car accidents, fights, suicides, alcoholism, workplace accidents and medical malpractice; 4, orthopedics, plastic surgery, dentures, prosthetics, organ transplants, named surgery, consultation fees, etc.; 5, reimbursement within the scope of the portion of the limit outside the scope of reimbursement. The above is to introduce you to the urban and rural residents of the basic medical insurance card related knowledge, I believe that through the introduction of the above, the urban and rural residents of the basic medical insurance card related knowledge has a better understanding.