A, the main purpose of the card
1, the main purpose of the card is to pay for outpatient visits. 2, health insurance has other uses, you can use the money in the designated pharmacy to buy drugs (over-the-counter medicines), medical equipment, thermometers and blood pressure monitors and other such auxiliary examination equipment. You can also pay for medical checkups and other out-of-pocket expenses. As we all know, the employee health insurance is generally divided into individual accounts and co-ordinated accounts, the two were how to use it? 1. designated retail pharmacy purchase costs, outpatient, emergency medical expenses; 2. used to buy their own commercial insurance, accidental injury insurance, etc.; 3. basic medical insurance co-ordination fund below the starting standard of medical fees; 4. more than the starting standard of basic medical insurance co-ordination fund, in accordance with the proportion of the individual payable costs; 5. personal account is not enough to pay for The individual account is not enough to pay part of the payment by the person himself.Second, the integrated fund mainly pays the following expenses:
1, hospitalization medical fees; 2, radiation therapy for malignant tumors, renal dialysis, kidney transplantation, outpatient medical costs of anti-rejection drugs; 3, emergency rescue patients admitted to hospitalization, the hospitalization of the patient's stay in the hospital for seven days before the medical costs.Three, the scope of reimbursement of medical insurance
1, the reimbursement of medical insurance card is limited to the designated hospital due to disease and some of the accident caused by the hospitalization of more than the medical expenses. The reimbursement formula is: (total cost - threshold fee - out-of-pocket expenses - overspending) * (75 + age * 0.2)%, under normal circumstances, the actual reimbursement rate ranges from 20 to 60%. Self-paying drugs are not reimbursed, 80% of Class B drugs are reimbursed, there is a limit to the bed charge, and some examination and treatment fees are not reimbursed according to the regulations. 2. The reimbursement amount of the health insurance card is 4 times of the local social wage (the cumulative value in 1 year). 3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency treatment, but it is not reimbursed because the money in the card is the money in the individual account of the medical insurance. 4. Reimbursement of major medical insurance Participants suffering from major illnesses, in the city health insurance designated medical institutions, in line with the provisions of the city's health insurance for the individual part of the burden, included in the residents of the major medical insurance payment scope, by the major medical insurance funds reimbursement of 50%. That is, the amount of reimbursement = deductible × 50%Four, medical card reimbursement ratio
The Ministry of Human Resources and Social Security announced in July this year, "human resources and social security development" Thirteenth Five-Year Plan Outline", China will be the employees and urban and rural residents of the basic China will stabilize the proportion of hospitalization expenses covered by medical insurance policies for employees and urban and rural residents at around 75%.Fifth, the new uses of the medical insurance card
1, can be used as an ID card On October 1, 2018, the Criminal Law Amendment (IX) included the social security card in the range of documents that can be used to prove identity according to law. Where the act of forging, altering, buying and selling social security cards, according to the law to investigate their criminal liability; where the use of forged, altered or stolen social security cards of others, according to the law to investigate their criminal liability. 2, some provinces and cities can be used for fitness Later this year, Shandong, Chongqing, Jiangsu, some provinces and cities, employees can use their personal account balances, fitness activities in fitness centers. But may not be used to buy food, clothing, fitness equipment or cash. 1, prohibit cash Any unit, individuals shall not violate the scope of use of health insurance cards and requirements, is strictly prohibited to cash. 2, part of the provincial and municipal health insurance card can be used by the whole family From the second half of this year, some provinces and municipalities, such as the province of Zhejiang, Guangzhou, health insurance personal account balance of funds over the years can be used to pay for the basic medical insurance for employees' spouses, children, parents and other close relatives of the medical insurance costs, the realization of family members of the ****ji mutual aid. 3, the following cases of medical insurance will not be paid in the non-designated medical structure or non-designated retail pharmacy purchase of drugs (except for emergency); due to their own fights, drug abuse or other illegal behavior caused by their own injuries; alcoholism, suicide, self-inflicted injuries and other reasons for medical treatment; due to traffic accidents, medical accidents, or other accidents resulting in injuries; and cases that should be paid by the individual according to national or local regulations.Six, how to query the balance of the health insurance card
Participants can call 12333 social security consulting phone or through the Bank of China Savings, urban designated hospitals, pharmacies and other ways to query the balance of the individual account of health insurance. Finally, if you are still unclear about health insurance, you can call the 12333 human resources social security hotline for advice. Older friends are much less physically fit than younger people, and with a health insurance card in hand, old age is one more safeguard. So, be sure to keep it, and use it wisely, both to save yourself money, but also to save trouble. Do not hurry to put this practical "Medicare card use manual booklet", give friends! How to correctly use the social security card Misunderstanding 1: Replacement of the social security card medical insurance personal account balance will be zero? Some of the participants believe that if the money in the personal account of the original card is not used up, the balance will be zeroed out when the new social security card is replaced. Ans: After the loss of the social security card due to loss, damage and other reasons, the replacement of the new card, the original card in the personal account funds, will be automatically transferred to the new card with the opening of the new card. Replacement of the new card during the same period as usual, according to the prescribed interest rate, the principal and interest in the personal account for the participants personal ownership, can be carried forward to use, inheritance according to law, will not be zero. Participants can check the account balance at the designated hospital or designated pharmacy, or go to the health insurance service hall of the county human resources and social security bureau to check the details of the individual account and the balance and so on.