What are the requirements for the second reimbursement of medical insurance?

The conditions for the second reimbursement of medical insurance are as follows:

1. Information required for the second reimbursement of serious illness medical insurance: When receiving the second subsidy, the original and photocopy of the second-generation resident ID card of the person who enjoys the second subsidy and his local bank card or passbook (except the rural commercial bank account) shall be held; If it is not handled by me, the original and photocopy of the agent's second-generation resident identity card are also required;

2. Reimbursement amount: "installment calculation, cumulative payment". The expenses above the "deductible line" and within 50,000 yuan incurred in the designated medical institutions of Beijing basic medical insurance shall be reimbursed by the serious illness insurance fund by 50%; Expenses exceeding 50,000 yuan shall be reimbursed by the serious illness insurance fund by 60%. Reimbursement method: the minimum compensation is 50% or 60%. First of all, critical illness insurance is not reimbursed according to the disease, but according to the total cost of medical treatment for this person within one year. If the expenses exceed a certain amount, no matter what disease the insured suffers from, they can be reimbursed according to the corresponding proportion. After the residents who participated in the urban residents' medical insurance were reimbursed for normal medical insurance, the remaining personal out-of-pocket expenses within the scope of medical insurance reimbursement exceeded the annual per capita disposable income of urban residents in the whole city in the previous year, and the excess could be reimbursed. If the excess is less than 50 thousand, it will be reimbursed by the serious illness insurance fund 50%; Expenses exceeding 50,000 yuan shall be reimbursed by the serious illness insurance fund by 60%. The same is true of the new rural cooperative medical system, except that the minimum payment of the new rural cooperative medical system is the annual per capita net income of rural residents in the whole city in the previous year, and the excess part paid by individuals is included in the scope of reimbursement.

legal ground

Article 26 of People's Republic of China (PRC) Social Insurance Law

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 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years stipulated by the state can pay the fees to the fixed number of years stipulated by the state at noon.

Article 28

The basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue medical expenses that meet the requirements of the state shall be paid by the basic medical insurance fund.

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;

(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.