How to make secondary reimbursement for medical insurance

The second reimbursement of medical insurance can be made by the person concerned by bringing his/her ID card, social security card and medical payment documents to the designated hospitals and so on. In accordance with the provisions of the social insurance system, within a year, the first reimbursement, the starting line amount of 1300 yuan, the second time in accordance with the first starting standard of 50% to determine, within a year, the maximum payment limit of medical insurance is 70,000 yuan, the starting line of emergency reimbursement for the active workers for 2,000 yuan, retired workers for 1,300 yuan, the starting line.

What are the requirements for secondary reimbursement under Medicare?

1, must be insured residents

Secondary reimbursement is after the first reimbursement anyway, because certainly if you are an insured resident, you can make a second reimbursement. If you are not even insured, then everything is empty.

2, a reimbursement after the cost is still very high

Usually, after a certain percentage of the first reimbursement after the medical treatment, the remaining costs are basically not too much. However, if the remaining medical expenses after the first reimbursement exceed the average annual per capita income of the local urban or rural residents, then you can apply for a second reimbursement.

How much is the second reimbursement?

The second reimbursement is also based on the specific hospital level, the higher the level, then the reimbursement rate will be less, such as community health insurance reimbursement rate is generally 35% -45%, the specific how much also need to be combined with the local rules, there may be differences between different regions.

So the reimbursement rate should be based on the local rules, and the reimbursement rate is different in different areas. In Beijing, for example, the reimbursement rate for secondary major medical insurance for expenses within 50,000 yuan (inclusive) is 50 percent, and the reimbursement rate for the portion of 50,000 yuan or more is 60 percent.

Legal basis:

Article 26 of the Social Insurance Law of the People's Republic of China

The standard of treatment of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the state regulations.

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29 of the Social Insurance Law of the People's Republic of China

The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.