The latest policy of medical insurance reimbursement in different places in Henan Province: the proportion of medical insurance reimbursement in different places for employees in Henan Province in 202

The latest policy of medical insurance reimbursement in different places in Henan Province: the proportion of medical insurance reimbursement in different places for employees in Henan Province in 2023 The latest policy of medical insurance reimbursement in different places

The first is the conditions for reimbursement of medical insurance in different places.

1. The medical expenses incurred by the insured who have gone through the registration procedures for medical treatment in different places, such as resettlement, visiting relatives, working and studying abroad, are paid in cash at the designated medical institutions of medical insurance in different places.

2, the provincial insured agreed to transfer to Beijing, Shanghai medical insurance designated medical institutions for medical expenses in cash.

Second, the reimbursement rate of medical insurance in different places (up to 90%)

1, outpatient reimbursement ratio

There is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service. Within a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed according to the proportion of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan.

2. Proportion of hospitalization reimbursement

. The longer the continuous insurance period, the greater the reimbursement ratio. The proportion of hospitalization reimbursement of medical insurance fund will be increased by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative reimbursement ratio will not exceed 10 percentage point. If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively.

3. Secondary reimbursement ratio

After the "second reimbursement", the medical expenses incurred by the insured residents in a single hospitalization belong to the part paid by the urban residents' basic medical insurance pooling fund, and there may be a "second reimbursement". After the basic medical insurance fund is paid in proportion, the personal burden exceeds 8,000 yuan, and the serious illness insurance fund gives "second reimbursement" to more than 55%.

After the basic medical insurance payment and "second reimbursement", the annual accumulated hospitalization medical expenses of the insured residents (including the compliant and reasonable self-funded part) exceed 25,000 yuan, and the excess part is "reimbursed" again by the serious illness insurance fund according to the proportion of 55%, and the annual maximum payment limit of the serious illness insurance fund is 250,000 yuan.

4. Reimbursement amount

The maximum annual reimbursement is 370,000 yuan for residents who participate in medical insurance for urban residents in our city. The annual payment limit for basic medical insurance is 6,543,800 yuan+0.2 million yuan, and the annual payment limit for serious illness insurance is 250,000 yuan. Therefore, Enoch Finance found that the insured can be reimbursed up to 370,000 yuan per year.

Third, the process of medical insurance reimbursement in different places.

1, to receive or download the Application Form for Working and Living in Different Places of the Municipal Basic Medical Insurance (hereinafter referred to as the Application Form) on the social security website;

2, according to the provisions of the fill in, and by the foreign social insurance (medical insurance) agencies stamped "declaration form";

3 will fill out the "declaration form" back to the social insurance agency responsible for the division of labor for review and confirmation. Need to apply for a medical card in different places in the province, with the "declaration form" after examination and confirmation to the municipal social security center audit department for registration, and then to the social security card management department for the card making procedures in different places in the province;

4. The insured person's personal social security card cannot be used after filing; If the insured person returns for medical treatment, he should go to the municipal social security agency for cancellation of medical registration, and his personal social security card can be used in designated medical institutions from the next day;

5. Implement the principle of reporting changes but not reporting.

Fourth, the materials needed for medical insurance reimbursement in different places.

1, copy of application form for medical treatment in different places

2. The formal invoice of pharmacy (supervised by State Taxation Administration of The People's Republic of China Finance Department, with the details of purchased drugs listed on the invoice) or the outpatient receipt of designated hospital.

3. Patient ID card and agent ID card

4. My passbook bank card account number (except for rural credit cooperatives) (bank name is required in external account)

Development direction of medical insurance reimbursement in different places

Yin Weimin, Minister of Ministry of Human Resources and Social Security, said that the problem of direct settlement of medical treatment in different places will be solved in three steps.

The first step: realize the direct settlement of medical treatment in different places in the province. Statistics show that the proportion of medical treatment in different places in the province is the largest. By the end of 20 16, 30 provinces in China had achieved card settlement for medical treatment in different places within the province. The second step: in the first half of this year, the hospitalization expenses of retired and resettled people across provinces will be directly settled. Yin Weimin said: "If you take retired parents to the place where their children work, you can see a doctor directly and settle accounts in different places."

Step 3: Before the end of this year, realize the direct settlement of hospitalization expenses of all eligible persons.

According to the report of Ministry of Human Resources and Social Security, the national remote medical treatment settlement system 20 16 was put into trial operation at the end of 2006. During the trial operation, 15 provinces have connected to the system and started the pilot project.

Medical treatment in different places is mainly aimed at four groups of people, namely:

1 Resettlement of retirees in different places, that is, people who have settled in different places after retirement and moved to their places of residence;

2. Long-term residents in different places refer to those who live in different places and meet the conditions of the insured place;

3. The resident in different places refers to the personnel who are stationed in different places by the employer and meet the conditions of the insured place;

4. Referrals from different places refer to those who meet the referral conditions of the insured place.

Previously, the medical expenses for medical treatment in different places were paid in advance by individuals, and after the treatment, I or my agent took the bill to the medical insurance center for reimbursement.

After the direct settlement of medical insurance across provinces and different places is realized, the insured citizens do not need to advance medical expenses (except at their own expense), and they do not need to take invoices for reimbursement. They only need to hold social security cards to seek medical treatment in designated hospitals. When seeing a doctor, the reimbursement ratio is directly settled on the card, and individuals only need to deposit their own funds directly on the card.

Related question and answer

1. Can medical insurance in different places be reimbursed?

A: Some pilot provinces and cities have begun to implement medical insurance settlement in different places, but the national standards are not necessarily the same.

Second, can medical insurance in different places be reimbursed?

Answer: General medical insurance cannot be reimbursed in different places, unless it can be reimbursed under some special circumstances:

1, generally cannot be used across regions;

2, under special circumstances, travel, visiting relatives, vacation and other reasons in different places emergency hospitalization medical expenses, should be reimbursed in accordance with the specific provisions of the local medical insurance measures. Generally, in an emergency, the nearest diagnosis and treatment is allowed. After treatment, with the valid certificate issued by the treatment hospital, the local medical insurance agency will be reimbursed according to the regulations.

3. In addition, if you have retired and your children have settled in Beijing, you can apply to the medical insurance center of the insured area for the relocation of retirees. After you do it well, you can choose one or two designated hospitals in XX, pay the expenses yourself first, and then go back to the medical insurance center where you are insured for reimbursement.

4. For employees who have been overseas for a long time, they can also apply for medical insurance resettlement in different places, and the unit can apply. After the completion, they can choose one or two designated hospitals in XX, pay their own expenses, and then be reimbursed by the medical insurance center in the insured area.

Third, how to reimburse emergency hospitalization medical insurance in different places?

Answer 1. Carry the patient ID card, two one-inch color photos and the new rural cooperative medical card to the county joint management office for referral and filing procedures;

2. Bring the patient ID card, the certificate of the new rural cooperative medical system and the referral filing procedures to the referral hospital for medical treatment, and go through the hospitalization procedures of the new rural cooperative medical system;

3, after discharge, with the patient's ID card (or household registration book), the new rural cooperative medical certificate, a copy of medical records, hospitalization statements (some in the form of invoices), hospitalization expenses list, referral filing procedures to the joint management office for reimbursement.