Proportion of medical expenses reimbursed by social security in different places

The proportion of medical expenses reimbursed by social security in different places is 70% to 95%.

Details are as follows:

70% to 95% Such as expensive drugs, special examinations and special treatments, 70% will be reimbursed; Class B drugs are reduced by 80%; 88% of the threshold fee is more than 3,000 yuan; 3000-5000 yuan is 90%; 5000- 10000 yuan is 92%; 10000 yuan to 95% of the maximum payment limit.

Social security and medical insurance reimbursement methods for hospitalization in different places;

1. First, you need to prepare the discharge summary, invoice and medication list, and then you need your valid ID card, medical insurance card and proof of medical treatment in different places. If the insured is an individual rather than an enterprise, there is no need to issue a certificate of medical treatment in different places;

2. To issue a certificate of transfer from different places in our hospital, the attending doctor needs to sign the certificate and then go to the hospital medical insurance office to handle the transfer certificate;

Then you can take the above information to the local medical insurance bureau for reimbursement. Generally, the reimbursement fee can be obtained within 3-7 working days at the earliest. In addition, the transfer certificate of the hospital must be issued. The reimbursement for medical treatment in different places will be less than that for local medical insurance 10%, and there will be 20% less if there is no hospital transfer certificate.

Social security off-site medical treatment filing process:

Go directly to the social security bureau of the insured place. After going in, a staff member will tell us how to go through the process. Generally, we only need to fill in two important information, one is the reason for filing the case and the other is the hospital. Fill these out clearly and wait for the staff to review them. After the approval, the record was successful.

To sum up, you need to open a referral certificate in the local (city) hospital, then go to the local social security office for approval and filing, then go to a different hospital to pay the full fee and go back to the local social security office for reimbursement.

Legal basis:

Article 29 of People's Republic of China (PRC) 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 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;

(3) borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.