Can the medical examination be reimbursed? Social security

you can't use the social security card to reimburse the medical examination, but you can use the money in the personal account of the medical insurance card to pay for the medical examination.

the medical insurance card has two accounts, one is an individual account, and the other is a co-ordination account, in which the money in the individual account can be used for general outpatient service, medicine purchase, etc., and the co-ordination account is generally used for reimbursement of hospitalization medical expenses of the insured.

scope of use of personal account in medical insurance:

personal account is used to pay the medical expenses borne by the insured in designated medical institutions or designated retail pharmacies; Individuals who participate in the basic medical insurance and long-term care insurance for urban and rural residents in this city pay fees and support the purchase of supplementary medical insurance in this city (especially Beijing Pratt & Whitney Health Insurance at this stage).

the personal account can be subsidized by the family, and the family members of the insured can use the funds of the insured's personal account in accordance with the provisions on the scope of use of the personal account.

First, the scope of medical insurance reimbursement:

1. The reimbursement of medical insurance card is limited to the medical expenses above hospitalization caused by diseases and some accidents in designated hospitals. The reimbursement formula is: (total expense-threshold expense-self-expense-cost overrun) *(75+ age *.2)%. Under normal circumstances, the actual reimbursement ratio ranges from 2% to 6%. Self-funded drugs are not reimbursed, 8% of Class B drugs are reimbursed, bed fees are limited, and some inspection fees and medical treatment fees according to regulations cannot be reimbursed.

2. The reimbursement amount of medical insurance card is four times the average salary of local social workers (accumulated value within one year).

3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.

4. After the insured suffers from a serious illness, the personal conceit that occurred in the designated medical institutions of the municipal medical insurance and met the requirements of the municipal medical insurance will be included in the payment scope of the residents' serious illness insurance, and 5% will be reimbursed by the serious illness insurance funds. That is, the reimbursement amount = self-funded part ×5% IV. The proportion of reimbursement for medical insurance cards The Ministry of Human Resources and Social Security announced the "Thirteenth Five-Year Plan for the Development of Human Resources and Social Security" in July this year. China should stabilize the proportion of hospitalization expenses within the basic medical insurance policy for employees and urban and rural residents at around 75%.

2. Differences between medical insurance pooling account and individual account:

1. Different functions:

Pooling account is mainly used for reimbursement of medical expenses such as hospitalization, referral from different places, outpatient chronic diseases or special diseases; Personal accounts are mainly used for small expenses other than medical insurance reimbursement, such as buying medicines at designated pharmacies, seeing doctors at outpatient clinics, and paying for the reimbursement.

2. Different funds are included:

Some funds are included in the overall account, and a small amount of funds are included in the personal account. The allocation ratio of the overall account and the personal account is different in different places, and the use scope of the personal account is also different.

3. The withdrawal amount is different:

The money in the overall account cannot be withdrawn, but the money in the personal account can be withdrawn if it meets the requirements. If the insured person dies, emigrates, or leaves his job and is transferred to other places, he can apply to withdraw the money from the personal account of the medical insurance card.

third, whether it is the money in the overall account or the money in the personal account, it can only be used for medical treatment and cannot be used for daily consumption.

1. Personal account is used for: outpatient and emergency medical expenses; The cost of purchasing drugs in designated retail pharmacies; Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund; Medical expenses that exceed the qifubiaozhun of the basic medical insurance pooling fund and should be borne by individuals in proportion.

2. Overall account: medical expenses for hospitalization; Emergency rescue observation and income hospitalization, the medical expenses within 7 days before hospitalization observation; Outpatient medical expenses of taking anti-rejection drugs after radiotherapy and chemotherapy, renal dialysis and renal transplantation for malignant tumors.

3. Social security is divided into two parts: the unit payment and the individual payment. The unit payment goes into the overall account, and the individual payment goes into the individual account. For example, if the pension insurance unit pays 2% of the employee's salary, it goes into the overall account, and the employee pays 8%. In medical insurance, part of the unit payment will be set aside in the employee's personal account (according to different local rules)

4. The money in the personal account belongs to the individual. In endowment insurance, when the employee dies before retirement age, the personal account of endowment insurance will be returned to the beneficiary. The money in the personal account of medical insurance is used by individuals, which can pay the outpatient fee, the personal self-paid part of social security medical care, buy medicines, etc., and the overall account is owned as * * *.

Legal Basis

Social Insurance Law of the People's Republic of China

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, work injury insurance, unemployment insurance and maternity insurance to protect citizens' rights to receive material assistance from the state and society in case of old age, illness, work injury, unemployment and maternity.

Article 3 The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(1) Those that should be paid from the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) It shall be borne by public health;

(4) seeking medical treatment abroad.

the medical expenses shall be borne by the third party according to law. if the third party fails to pay or cannot determine the third party, the basic medical insurance fund shall pay in advance. After the basic medical insurance fund has paid in advance, it has the right to recover from the third party.