How much can the social security card be reimbursed?

Generally, the reimbursement rate of social security card is 60% if it belongs to the village clinic and the village center clinic. Belong to the town hospitals, reimbursement of 40%; Belong to the secondary hospital, reimbursement of 30%; Belong to the tertiary hospital, reimbursement of 20%. The outpatient and emergency medical expenses that meet the requirements of social security (1.1-12.31) and exceed 1800 yuan every year will be reimbursed by 50% in designated non-community medical institutions and 70% in the community.

If this is the first reimbursement this year, the medical expenses incurred will be 2,000 yuan after deducting social security self-funded items and self-funded items, of which 1800 cannot be reimbursed and shall be borne by individuals. If 200 yuan is multiplied by 50% (non-community) or 70% (community), the reimbursement fee is 65,438 yuan+0,400 yuan. The maximum social security reimbursement is 20,000 yuan.

Hospitalization, the first hospitalization1more than 300, and later hospitalization of more than 650. Medical expenses below 30,000 yuan shall be reimbursed by 85% (level III hospital, the same below), 30,000-40,000 yuan shall be reimbursed by 90%, and more than 40,000 yuan shall be reimbursed by 95%, with a maximum payment of 70,000 yuan. If the maximum annual payment exceeds 70,000 yuan, it will be reimbursed at the rate of 70%, and the maximum annual social security payment is170,000 yuan (excluding outpatient and emergency services).

How to reimburse social security cards?

Take the social security card issued by the company to the hospital for reimbursement. The specific process is as follows:

1. First of all, when the insured goes to see a doctor, he goes to the registration office with his social security card.

2. The insured person goes to the clinic with the registration form, and the doctor will prescribe the payment after reading it for the insured person.

3. After the insured person takes the prescription to the hospital settlement window for pricing, he can directly brush the social security card to pay the medical expenses within the scope of medical insurance fund payment.

4. If some drugs in the prescription are not covered by the medical insurance fund, the insured needs to pay cash.

The reimbursement scope of social security card is the reimbursement scope of five guarantees in our social insurance, including:

1. Medical insurance reimbursement and reasonable and necessary medical loss compensation within the scope of social security catalogue;

2. Unemployment insurance reimbursement is aimed at employees who are unemployed for non-personal reasons and have the willingness to apply for a job, and can receive unemployment insurance benefits on a monthly basis;

3. Reimbursement of maternity insurance, payment of maternity allowance and related medical expenses compensation according to the situation of birth or large and small fetus;

4. Reimbursement of work-related injury insurance refers to the compensation for death, disability and medical expenses caused by the responsibility of work-related accidents, as well as the liability for compensation for occupational diseases.

In addition, for the rights and interests of old-age security, you can apply for old-age benefits through social security cards.

legal ground

Article 28 of the Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29 of the Social Insurance Law

The medical expenses of the insured shall be paid by the basic medical insurance fund, and 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.

Article 3 1 of the Social Insurance Law

According to the needs of management services, social insurance agencies can sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior. Medical institutions shall provide reasonable and necessary medical services for the insured.

Article 32 of the Social Insurance Law

If an individual is employed across the overall planning area, his basic medical insurance relationship will be transferred accordingly, and the payment period will be calculated cumulatively.