Does the social security card only reimburse hospitalization?

No, medical insurance can not only be reimbursed for hospitalization. First of all, medical insurance is divided into basic medical insurance and hospitalization medical insurance. Basic medical insurance requires both units and individuals to pay medical insurance premiums, while hospitalization insurance is paid by units. Some medicines and emergency expenses in general outpatient clinics can be reimbursed without hospitalization.

Social security card reimbursement conditions: the applicant has gone through the insurance formalities and paid the medical insurance premium in full; The insured person has incurred hospitalization expenses in the medical institution for the record, paid in advance, and saved relevant documents and materials, and can only be reimbursed if the above conditions are met. However, it is not only hospitalization that can be reimbursed. Hospitalization can only be reimbursed in designated hospitals. Outpatient and hospitalization can be reimbursed in proportion, and social security card outpatient reimbursement is more obvious.

First of all, the money in our medical insurance account and personal account can be directly used as cash. For example, if we usually have a headache and fever, we can go to a designated medical institution or a designated retail pharmacy to buy medicine and cold infusion, and we can directly brush the money in the personal account of the medical insurance card;

Secondly, if the annual medical expenses exceed the minimum deductible line (the standard in different areas of Beijing is 1800 yuan), the medical insurance can reimburse us in proportion. The higher the hospital level, the lower the reimbursement rate.

To sum up, social security card can not only reimburse hospitalization, but also reimburse outpatient service. Now social security card and medical insurance card are combined into one, and social security card gradually replaces medical insurance card.

Local reimbursement process of social security card

1. When entering or leaving the hospital, you must go through the registration formalities with the medical insurance IC card at the medical insurance management window of each designated medical institution. When in hospital, the individual pays the deposit of medical expenses in advance, and pays more and less after discharge.

Medical expenses incurred before hospitalization registration are not included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, the emergency certificate should be used to go through the hospitalization formalities at the medical insurance management window the day after admission (postponed in case of holidays), and the overdue medical expenses should be borne by themselves.

2. The deductible line of the overall fund after the insured person is hospitalized: the deductible line varies from place to place, which is generally 10% of the average annual salary of employees in the whole city in the previous year. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.

3. If the insured person needs to be referred or transferred due to illness, the deputy chief physician or chief physician of the designated medical institution at or above the third level shall put forward the opinions of referral (hospital) after diagnosis, and the unit to which he belongs shall fill in the application form and go through the referral (hospital) formalities with the approval of the medical insurance management department of the designated medical institution.

The transfer is limited to provincial specialized hospitals, and the expenses are paid by me first. The reimbursement standard is 10% first, and then the reimbursable amount is calculated according to local regulations.

4. When the designated medical institutions are discharged from the hospital, the designated medical institutions will calculate the reimbursement amount of medical insurance and the amount that individuals should pay. The reimbursement amount will be settled by the designated medical institutions and urban social insurance agencies, and the amount that individuals should pay will be settled by the designated medical institutions and the insured.

China's current national insurance policy is of positive significance for alleviating social medical contradictions and citizens' treatment pressure. However, in the case of medical treatment in different places, reimbursement in different places can also be carried out in accordance with the prescribed procedures and methods, but it must conform to the policies of the two places, otherwise the social security department cannot recognize and handle it.

Legal basis:

Article 64 of the Social Insurance Law of People's Republic of China (PRC) includes basic old-age insurance fund, basic medical insurance fund, industrial injury insurance fund, unemployment insurance fund and maternity insurance fund. In addition to the basic medical insurance fund and maternity insurance fund combined accounting, other social insurance funds are accounted for separately according to social insurance types. Social insurance funds implement a unified accounting system throughout the country. The social insurance fund is earmarked for special purposes, and no organization or individual may occupy or misappropriate it. The basic old-age insurance fund will gradually implement national overall planning, and other social insurance funds will gradually implement provincial overall planning. The specific time and steps shall be stipulated by the State Council.