What are the scope of use of Shanghai medical insurance card?

Nowadays, the number of people applying for medical insurance is increasing day by day, but in Shanghai, most of them don't need it. How to use the medical insurance card? The following is some information about the use of Shanghai Medical Insurance Card compiled by Zhishi Bian Xiao for your reference.

How to use Shanghai medical insurance card? The insured shall report the loss of the social security card (used for medical insurance) (hereinafter referred to as the "medical insurance card"), and the specific measures are as follows:

1. Call the medical insurance hotline 9622 18(24-hour service) to report the loss. When reporting the loss, the insured's name, ID number, medical insurance card number and unit name shall be truthfully provided. Upon confirmation by the medical insurance staff, the telephone reported the loss successfully, and the card was stopped for settlement within 1 hour. If the information provided is incomplete or incorrect, so that the telephone loss cannot be confirmed, the insured shall report the loss in writing in time.

2. Bring my valid certificate (ID card, household registration book, etc.). ) Go to the nearest city, county medical insurance center or street (town) medical insurance service point (hereinafter referred to as the service point) to handle the written loss reporting procedures. The medical insurance staff will stop the card settlement within 1 hour after confirming the success of the loss reporting operation.

Two, the insured person before re applying for the "medical insurance card", the original "medical insurance card" should go through the formalities of reporting the loss of cancellation, the specific measures are as follows:

1. Bring my Medical Insurance Card and valid certificates (such as ID card, household registration book, etc.). ) and go to the nearby city, district and county medical insurance center or service point to report the loss and cancel.

2. The city, district and county medical insurance centers or service points cancel the loss reporting operation on the spot, and the medical insurance staff will resume the card settlement within 1 hour after confirming the successful cancellation of the loss reporting operation.

Three, the insured person lost or damaged the "medical insurance card", can apply for a new card, the specific measures are as follows:

1. Bring my valid certificate (such as ID card, household registration book, etc.). ) and apply to the neighboring county medical insurance center, which can be handled on the spot.

Scope of application of Shanghai medical insurance card The role of medical insurance card

The public generally knows that one function of medical insurance card is to pay by credit card in emergency room. However, there are two kinds of medical insurance cards that you must know: pharmacy to buy medicine and show your medical insurance card when you are in hospital.

Correct use of medical insurance card

(1) The doorman pays by credit card for emergency treatment: generally, the registration fee for outpatient and emergency treatment of 10 yuan is only a few dollars after swiping the card; 2 pharmacy to buy medicine: this medicine must be within the scope of medical insurance. Not all medicines are available. Of course, if you don't specifically require a certain brand, most drugs are available; ③ Show your medical insurance card when you are hospitalized: the hospitalization expenses will be automatically excluded, excluding the self-funded part, according to the reimbursement ratio.

How can the money in the medical insurance card account see a doctor?

(1) If you need to be hospitalized for a serious illness in the hospital, it is very simple. Just give the card to the hospital and you can feel at ease. Take the medical insurance reimbursement standard for on-the-job employees as an example. First of all, the part below the deductible 1500 yuan needs to be borne by yourself. For the part exceeding the deductible, the medical insurance will bear 85%, and the individual will bear 15%. The maximum payment limit is 420,000 yuan. For the part exceeding 420,000 yuan, medical insurance will bear 80% and individuals will bear 20%.

(2) See if the outpatient service is emergency? Then the balance in the card will be used to pay for outpatient and emergency treatment. What if the balance in the card is all used up? Out of your own pocket, don't worry, it won't be a bottomless pit. Self-paid part 1500 yuan. When our self-funded amount exceeds 1500 yuan, part of the expenses can be reimbursed. The reimbursement rate varies from 50% to 75% according to the patient's age and hospital level.

(3) The self-paid part can be accumulated. As long as it reaches 1500 yuan per year, the excess part can be reimbursed in proportion. Retired employees have higher reimbursement standards! Retirees who are hospitalized beyond the deductible only need to pay 8%, and most of them are paid by the state.

Do I have to go to a community hospital first to see a doctor?

Not necessarily. Shanghai is signing up community family doctors on a pilot basis, and residents choose three medical institutions (a community hospital, a district-level medical institution and a municipal medical institution). What are the benefits? After the residents sign the contract, it means that there are more family doctors. Residents can seek medical treatment free of charge in the first, second and third-level hospitals signed. If you want to see a doctor in a hospital outside the contract, you need a family doctor to refer you and enjoy the green channel for referral.

Another big benefit after signing the contract is that you will enjoy the advantages of chronic diseases and medical insurance reimbursement, and you can also get prescription drugs from top three hospitals in community hospitals.

It should be emphasized that the right to choose whether to sign a contract is in the hands of residents, and the original medical habits of residents who do not sign a contract will not be affected.

Lending the medical insurance card to others will have serious consequences.

Remember the news many years ago? The daughter used her father's social security card to buy medicine for her mother, and both mother and daughter were sentenced. So remember that the medical insurance card must not be lent or abused. The medical insurance card can only be used by the cardholder himself, and may not be rented or lent.

Shanghai social security card use process 1, medical insurance is divided into two accounts, personal account, and the money reflected in the medical insurance card can be used to buy medicines at designated pharmacies, pay outpatient expenses and pay the out-of-pocket part of hospitalization expenses; The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account.

2. Citizens participating in medical insurance use social security cards to seek medical treatment, purchase medicines, settle medical expenses and handle medical insurance affairs, which is the same as using medical insurance special (magnetic stripe) cards. The original medical insurance benefits of citizens participating in medical insurance remain unchanged, and citizens still enjoy medical insurance benefits in accordance with the provisions of the Measures of Shanghai Municipality on Basic Medical Insurance for Urban Workers.

3. When seeing a doctor, show the medical insurance card to the designated hospital to prove the identity of the insured. At the time of checkout, the part paid by the individual is paid by medical insurance card or cash, and the part reimbursed by medical insurance is settled by medical insurance and hospital, so the individual does not need to pay first and then reimburse.

4. When using the social security card to handle medical affairs, the remaining amount in the personal account of the insured citizen can be carried forward for use, which will not be invalid due to the use of the social security card, and the insured citizen will not lose the funds in the personal account due to card replacement.

5. If you want to check the amount in the card, you can log on to the website of Shanghai Social Security and change your password online. If not, you can change it on the special machine in the local medical insurance center. The initial password settings are still different from place to place. If the social security card is accidentally lost or damaged, citizens can bring their ID cards or their own and their clients' ID cards to the social security card redemption service outlets in all districts and counties for redemption and replacement. When going through the formalities of card replacement and replacement, you should fill in the Shanghai Social Security Card Application Registration Form and submit your ID card.

How to use Shanghai medical insurance card