How to reimburse medical insurance now

202 1 the new medical insurance policy was promulgated.

1. Don't resell other items with the medical insurance card.

I don't know if you have ever seen such a situation in a drugstore. In addition to selling basic drugs, they also sell some daily necessities, which can also be settled by medical insurance cards. Nowadays, many people pay a fixed fee for their medical insurance cards, but because they are not used many times every day, a lot of money is accumulated in the medical insurance cards. How can pharmacies make money without spending this money? So the drugstore thought of selling daily necessities.

In addition, some pharmacies will introduce drugs from some informal pharmaceutical factories through their own purchase channels. Although it will not cause serious harm to people's health, it will never have the effect of regular drugs, which is simply deceiving consumers. At the same time, it is also an act that does not abide by professional ethics.

2. Personal medical insurance cards can be lent to family members.

Second, the principle of "one card and one person" is required before the medical insurance card, because this can effectively protect the legitimate rights and interests of the insured from infringement. After all, people spend a lot of money on medical insurance every year. In case it is stolen, the loss is not heavy. When the cardholder is inconsistent with the insured, the medical staff may refuse to serve him. But now this policy has changed to a certain extent. A person's medical insurance card can be lent to others, but only to his own family, and only part of the funds are allowed to be used. In any case, this policy is more humane than before.

3. Repeated reimbursement is prohibited.

Third, now that people are working, employees' social security is paid by enterprises, including urban medical insurance. Before paying this insurance, I believe many people paid cooperative medical care. When people need to pay medical expenses, urban medical insurance can help reduce part of the expenses. Of course, people need to bear the rest themselves. However, in one case, although some expenses have been reimbursed, the family members who have paid the rural cooperative medical care are still trying to help them reimburse. In fact, this kind of behavior is illegal at first glance, and it is considered insurance fraud, so such a situation is not allowed. If this happens, the state will investigate the responsibility.

4. Medical personnel and medical institutions are restricted.

In addition to the above three points, it is also important to restrain medical personnel and medical institutions. They must keep patients' relevant information and medical data, and must not excessively induce patients to ask for consultation, and must not let patients buy drugs repeatedly, and must not let patients be hospitalized unnecessarily. All these behaviors will be defined as insurance fraud, and those involved will have to pay a large amount of fines. According to this new regulation, insurance fraud will be effectively curbed.

Legal basis:

Guiding opinions on strengthening and improving medical insurance participation II. primary mission

(a) A reasonable set of insurance coverage targets.

All localities should scientifically and reasonably determine the annual enrollment expansion target according to the local resident population, registered population, employed population, urbanization rate and other indicators. The basic medical insurance for employees (hereinafter referred to as "employee medical insurance") should gradually cover the local working population, and the basic medical insurance for urban and rural residents (hereinafter referred to as "resident medical insurance") should gradually realize the coverage of local non-employed residents. Further implement the residence permit insurance policy.

(2) Implementing the insurance compensation policy.

Adhere to and improve the basic medical insurance system covering the whole people and participating in insurance according to law. Medical security departments at all levels should improve the data sharing and exchange mechanism with local public security, civil affairs, human resources and social security, health and health, market supervision, taxation, education, justice, poverty alleviation, disabled persons' federations and other departments, strengthen the comparison and sharing of personnel information, verify the situation of people who have stopped insurance, accurately locate the uninsured, and form a national insurance plan library in the region. Personnel who sign labor contracts with employers and establish stable labor relations shall participate in employee medical insurance in accordance with regulations. Implement the subsidy policy for eligible people with difficulties to participate in residents' medical insurance. Focusing on migrant workers, urban and rural residents, disabled people, flexible employees and people with difficulties in life, we will strengthen insurance services and implement various insurance policies. Improve the payment methods for employees participating in new forms of employment.

(3) Do a good job of cross-system participation.

The insured person has participated in the basic medical insurance for more than two consecutive years (including two years), and the insured relationship has switched between employee medical insurance and resident medical insurance due to personal identity changes such as employment. If the payment is interrupted for no more than three months, the insured person can enjoy the treatment normally after payment, ensuring the seamless connection of the insured person's treatment. If the payment is interrupted for more than 3 months, each co-ordination area can set a waiting period of no more than 6 months according to its own situation, and the original insured relationship will be suspended after the waiting period expires.

(4) Clean up duplicate insurance in an orderly manner.

Repeated enrollment refers to the same insured person's repeated enrollment under the same basic medical insurance system (repeated enrollment within the system) or repeated enrollment under different basic medical insurance systems (repeated enrollment across systems), which is embodied in the fact that the same insured person has two or more normal enrollment payment records in the same time period. In principle, repeated insurance is not allowed.

Repeatedly participating in employee medical insurance, in principle, retain the employment insurance relationship; Repeatedly participating in residents' medical insurance, in principle, keep the insured relationship of permanent residence; Students who repeatedly participate in the insurance shall, in principle, retain their school status. Cross-system repeated insurance and continuous participation in employee medical insurance 1 year or above (including 1 year), in principle, the employee medical insurance participation relationship is retained. In the above circumstances, while retaining one insured relationship, the duplicate insured relationship should be terminated in time. Repeatedly participate in cross-system insurance in the form of flexible employment such as part-time and temporary work, retain the insured relationship that can enjoy the treatment, and suspend the repeated insured relationship.

(5) Improve the personal insurance payment service mechanism.

After the completion of the basic information management subsystem of the national medical insurance information platform, the medical security departments at all levels should make use of the real-time check function of the basic information management subsystem of the national unified medical insurance information platform to inquire about the payment of the insured in time, cooperate with the tax authorities to improve the insurance payment service and reduce the repeated insurance payment. Increase the publicity and guidance of insurance payment, promote the service to sink to the grassroots level, increase the promotion and use of medical insurance electronic certificate, expand diversified insurance payment channels by using mobile terminals, network platforms, sharing economic platforms and other channels, improve the awareness of insurance payment policies, and enhance service convenience.

After paying the residents' medical insurance premium, the insured can apply for a refund for the individual at the same time because of repeated payment before the start of the corresponding treatment enjoyment period, or participating in employee medical insurance or other regional medical insurance as a whole, and terminating the medical insurance participation relationship of the relevant residents. After the start of the treatment period, the individual payment part will not be returned to the suspended residents' medical insurance participation relationship in principle; Recipients who have enjoyed the subsidy for insurance payment through medical assistance channels may, according to their applications, complete the refund by terminating the payment channels of the insurance relationship as needed; Flexible employees pay medical insurance premiums once a year, and if they participate in employee medical insurance with the unit during their employment, they can return the medical insurance premiums paid by flexible employees in the remaining months of the year after their employment according to the application; In other cases, the provincial medical security department shall, in conjunction with the relevant departments, make clear the specific circumstances of refund and non-refund in light of local conditions.

(six) to strengthen the management of financial subsidies.

In addition to the college students who participated in the residents' medical insurance repeatedly in the same year, other people who participated in the residents' medical insurance repeatedly need to terminate the relevant residents' medical insurance participation relationship and deduct the financial subsidy funds at all levels involved in the repeated insurance year. Cross-system repeated insurance and continuous participation in employee medical insurance 1 year or above (including 1 year), and the payment status of insurance is normal, the financial subsidy funds at all levels for repeated insurance of residents' medical insurance in that year shall be deducted after treatment according to the principles stipulated in this opinion.