Can I use my social security card to buy medicine at the drugstore for reimbursement? What's the ratio?

First, use the social security card to buy medicine at the pharmacy, and only the insured person can buy medicine at the designated pharmacy with an external prescription for reimbursement.

The demand of designated pharmacies to buy drugs is that the insured holds a prescription for external use and can only be reimbursed if it meets the requirements of designated pharmacies and prescriptions for external use.

Take Beijing as an example:

Designated retail pharmacies in Beijing can provide basic medical insurance services for the insured. When the insured person shows his prescription and social security card at the designated pharmacy, he can realize the "second report" just like seeing a doctor at the designated hospital.

To realize the real-time settlement of drug purchase in designated pharmacies, doctors need to issue external prescriptions after outpatient (emergency) consultation in designated medical institutions and upload prescription information to the medical insurance information system in real time.

When the insured person goes to the pharmacy to get medicine, he will show his prescription and social security card. Designated retail pharmacies download the prescription information uploaded by designated medical institutions from the medical insurance network, compare the information with the paper prescription, dispense drugs according to the prescription drug information, and use social security cards to settle the drug expenses for the insured.

The insured person only needs to bear the personal burden, and the expenses paid by the medical insurance fund are paid in advance by the designated pharmacies. The reimbursement period of external prescription expenses will be changed from several months to several seconds, and the settlement and reimbursement will be completed in one step, making it more convenient and faster for insured people to buy medicines at designated retail pharmacies.

Second, the reimbursement ratio.

1, outpatient and emergency medical expenses: the medical expenses that meet the requirements of basic medical insurance in the year (11October1February 31February) exceeded 2,000 yuan.

2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.

3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.

The scope of medical insurance reimbursement varies from place to place. Please refer to local policies for details.

Extended data

Reimbursement process

For all participants, the reimbursement process is as follows:

(a) participating farmers to "new rural cooperative medical certificate" in designated institutions for outpatient treatment, by the designated medical institutions according to the "new rural cooperative medical certificate" family outpatient account existing amount directly reduce medical expenses, the excess paid by participating farmers. Designated medical institutions shall settle accounts with agricultural medical institutions in a timely manner.

(two) participating farmers in the city, county and township designated medical institutions for hospitalization, directly subsidized by the designated medical institutions. Audit the medical expenses incurred by designated medical institutions, and prepay the subsidy amount according to the standards stipulated in the implementation measures.

Participating farmers in the provincial designated medical institutions and non-designated medical institutions hospitalization, compensation by the township agricultural cooperative medical institutions. Hospitalization medical expenses, one-time less than 2000 yuan (including 2000 yuan), by the township (town) agricultural medical reimbursement, hospitalization data by the township (town) agricultural medical examination and approval before reimbursement.

(1) When applying for compensation, I need to bring my ID card, household registration book, new rural cooperative medical certificate (the original copies of these three certificates are kept below), valid hospitalization invoice of medical institution, discharge summary (or medical record), expense list and referral certificate.

(II) The participating farmers suffering from outpatient serious illness (chronic disease) shall go to the township (town) Agricultural Medical Office with their ID card, household registration book, new rural cooperative medical system, outpatient invoice and list, outpatient medical records, inspection report, and outpatient serious illness (chronic disease) certificate from a second-class hospital or a specialized hospital.

(III) For participating farmers who have participated in commercial insurance and students who have participated in student medical insurance, when both commercial insurance compensation and new rural cooperative medical system compensation are required after discharge, participating farmers should first submit the original hospitalization invoice and a copy of the invoice to the Agricultural Institute or the designated medical institution at the county level for compensation, and then pay the original hospitalization invoice to the commercial insurance company. Copies of invoices shall be kept by county-level agricultural medical institutions or designated medical institutions, but trauma patients can only be reimbursed by the original (except students).

(4) The hospitalization expenses shall be settled within a limited time, and the compensation and settlement procedures can be handled at any time within three months after discharge. Those who spend more than three months are deemed to have given up compensation on their own (migrant workers may delay until the end of the year). The amount of compensation payable by the Agricultural Medical Institute according to the standards stipulated in the Implementation Measures shall be paid to the participating farmers within 10 working days.

Xinhuanet-Beijing: From next week, designated pharmacies can brush social security cards for real-time settlement.

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