Proportion of medical insurance reimbursement in Foshan

In a social security year, the medical expenses paid by individuals included in the scope of serious illness insurance, which are less than 20 thousand yuan in total, shall be borne by individuals;

Accumulated more than 20 thousand yuan (inclusive) to 50 thousand yuan, paid by the serious illness insurance fund 60%;

70% of the total amount exceeding 50,000 yuan (inclusive) to 654.38+10,000 yuan shall be paid by the serious illness insurance fund;

80% of the accumulated part exceeding RMB 654.38+10,000 (inclusive) shall be paid by the serious illness insurance fund.

For the insured who have participated in the basic medical insurance for employees and residents in this city, within a social security year (if they are hospitalized in cross-social security year, they will be approved according to the date of discharge), and the medical expenses paid by individuals within the policy range (except for the basic medical insurance Qifubiaozhun) have accumulated more than 20,000 yuan, which will be included in the coverage of serious illness insurance according to the above table, with a maximum reimbursement of 200,000 yuan.

Legal basis:

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

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.

Derivative problem:

How to check the balance of medical insurance card? First, Alipay/WeChat inquiry. Take Alipay as an example. Select "city service" in the "convenient life" column of Alipay. Then enter the social security information of your city, and you can directly inquire about the payment situation and payment details of the five insurances, including the balance of course.

Two, log in to the city's social security card information network for inquiry. Select "Online Processing" in the navigation bar to query.

Third, telephone inquiry. Check the balance through the bank phone tied to the social security card.

Fourth, window or terminal query. Bring my valid certificate and social security card to the window of the service hall of the local social security bureau for inquiry; With a valid ID card or social security card, go to the nearest street, town community affairs acceptance service center or the nearest regional social security institution, and inquire social security information through the self-service inquiry machine.

Five, in the city designated hospitals and pharmacies to buy. After buying medicine at a designated drugstore and swiping the card, you can usually buy a receipt, and the balance will be displayed on the receipt.