How to reimburse medical insurance supplementary insurance?

Compared with basic medical insurance, supplementary medical insurance is a powerful supplement to basic medical insurance and an important part of multi-level medical security system. I hope it will help everyone. 1. How to reimburse supplementary medical insurance depends on what supplementary medical insurance your company buys. If it is social security supplementary medical insurance, it can be directly reimbursed when paying medical expenses, or it can be submitted to the medical insurance center in the region to provide corresponding invoices and medical records for reimbursement. If it is commercial medical insurance, you need to contact the insurance company and submit medical records, expense lists, social security split sheets and other claims materials to apply for reimbursement. 2. What is the latest reimbursement rate of personal medical insurance? 1. Outpatient reimbursement ratio Employees who participate in the basic medical insurance for urban employees can only be reimbursed for medical expenses of more than 2,000 yuan after seeing a doctor in the emergency department of the hospital, and the reimbursement ratio is 50%. For retirees under the age of 70, the expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then this 500 yuan can be reimbursed 50%, that is, 250 yuan. 2. Proportion of reimbursement for hospitalization At present, when the basic medical insurance is used for the first time in a year, the minimum payment for both employees and retirees is 1.300 yuan. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan. Third, the scope of medical insurance reimbursement First of all, the difference between medical insurance drugs and non-medical insurance drugs, the reimbursement deductible line is also different according to the level of the hospital. Generally, Class A drugs can enjoy full coverage, Class C drugs need to be paid at their own expense, and Class B drugs need to report 80% and pay 20%. A person spends 10000 yuan in a hospital. If he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you can deduct 2000 yuan first, which is the difference of deductible. Secondly, medical insurance also has exclusions. The following ten items are not included in the scope of medical insurance reimbursement: 1, the cost of organ and tissue transplantation due to illness, the cost of purchasing organ and tissue, and the cost of using anti-rejection drugs and immunomodulatory drugs beyond the scope of medical insurance reimbursement for employees in Zhenjiang; 2. Work-related injuries and occupational diseases; 3. Female workers give birth; 4. Rogue fights; 5. Injuries caused by alcoholism; 6. Traffic accidents; 7. Others intentionally hurt; 8. Medical malpractice; 9. Beauty and health examination; 10, other expenses not paid by the social medical insurance fund. Iii. Policies and regulations on reimbursement of medical expenses incurred by insured employees on business trips, visiting relatives and living in different places for a long time 1. Insured employees traveling on business or visiting relatives in other places will only be reimbursed for emergency expenses in other places that meet the requirements of medical insurance, and all expenses will not be reimbursed for non-emergency hospitalization. 2, the insured workers living in the field for more than 6 months, according to the nature of long-term living in the field of medical expenses. 3. Long-term residents in other places should be certified by the unit, and two designated hospitals (which should be designated medical institutions for local medical insurance) should be identified, and the medical expense reimbursement card for long-term residents in other places in Zhenjiang City should be handled in time. 4. Long-term residents in other places must adhere to the principle of economy and prescribe drugs in a limited amount according to regulations (the acute dose is within 3 days, the chronic dose is within 10 days, and the dose of tuberculosis, hypertension and diabetes can be extended to 30 days). 5, long-term residence in the field of referral, need to be signed by the local designated hospitals, step by step according to the principle of territoriality, referral hospital for the city's medical insurance to determine the special hospital. The individual pays 65438+ 00% of the total expenses first, and then reimburses the expenses according to the medical insurance regulations. Other hospitals and individuals pay 20% of the total expenses first, and then reimburse medical expenses according to medical insurance regulations. The above is all the contents of this article, from which we can know how to reimburse supplementary medical insurance, what is the latest reimbursement ratio of individual medical insurance and what is the reimbursement scope of medical insurance. They are online 24 hours a day and can answer your legal questions at any time.

Legal objectivity:

Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations. "People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.