How to reimburse Suzhou uremia medical insurance

Reimbursement of uremia can be divided into the following two types:

1, reimbursement of new rural cooperative medical insurance:

The rural cooperative medical insurance is purchased in the same year, and will be reimbursed in the following year. The minimum cost is 20 yuan/year/person. The reimbursement of cooperative medical insurance needs to be made at the medical insurance checkout window of the local cooperative medical management institution or designated medical institution.

Procedures include: my ID card, medical insurance card, original invoice, medication list, medical records and other materials.

The reimbursement of cooperative medical insurance is carried out in proportion, generally fluctuating around 20-85%. The proportion and amount of reimbursement are related to their own examination and medication, medical level and other factors. For example, it is clear that Class A drugs can enjoy full coverage, Class C drugs need to bear all the costs, and Class B drugs will report 80% and bear 20% of the costs.

2, urban workers and residents medical insurance reimbursement:

The proportion of hospitalization expenses in the basic medical insurance policy of urban workers' medical insurance and residents' medical insurance reached about 75%, and the burden of individual medical expenses of residents continued to be reduced. Local medical institutions voluntarily reduce the fixed expenses to a certain standard. Under this premise, there is no threshold to bear the "zero burden" of insured employees and the 80% reimbursement ratio of insured residents. Insured people voluntarily choose medical institutions within a certain range to achieve "zero burden" or 80% reimbursement.

The procedures required for reimbursement include: my ID card, medical insurance card, original invoice, medication list, medical records and other materials.

Payment standard:

1. Insured persons who have completed the registration and confirmation procedures for specific items of uremic dialysis outpatient service, according to the cumulative situation of specific items of hospitalization and outpatient service in that year, if the expenses of uremic dialysis (including hemodialysis, peritoneal dialysis and use of recombinant human erythropoietin injection) meet the requirements in each settlement year, they will directly enter the settlement part of the corresponding medical insurance fund: 90% of the accumulated expenses within 40,000 yuan will be settled; 95% will be paid for the part exceeding 40,000 yuan.

2. In each settlement year, if the accumulated expenses of specific items of hospitalization and outpatient service of the insured are less than 654.38+10,000 yuan, they shall be paid by the basic medical insurance pooling fund according to regulations; Expenses exceeding 654.38+10,000 yuan shall be paid by the social pooling fund for large medical expenses according to regulations.

To sum up, no matter the reimbursement of the new rural cooperative medical system or the reimbursement of urban workers and residents, they must go to the local cooperative medical management institution or the medical insurance checkout window of designated medical institutions for reimbursement.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 26

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

Article 28

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

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 30

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

(a) shall be paid by the industrial injury insurance fund;

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

(three) shall be borne by public health;

(4) Go abroad for medical treatment.