Can the medical examination be reimbursed? social security

Physical examination cannot be reimbursed by social security card, but the money in the personal account of medical insurance card can be used to pay for physical examination.

The medical insurance card has two accounts, one is a personal account and the other is a co-ordination account. Among them, the money in the personal account can be used for general outpatient service and drug purchase, and the overall account is generally used for reimbursement of hospitalization medical expenses of insured persons.

The scope of medical insurance personal account:

Personal accounts are used to pay the medical expenses incurred by the insured in designated medical institutions or retail pharmacies; Individual contributions to the basic medical insurance and long-term care insurance for urban and rural residents in this city support the purchase of supplementary medical insurance in this city (especially Beijing Pratt & Whitney Health Insurance at this stage).

Personal accounts can be used for family subsidies, and family members of the insured can use personal account funds in accordance with the provisions of the scope of use of personal accounts.

First, the scope of medical insurance reimbursement:

1, medical insurance card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to diseases and some accidents. The reimbursement formula is: (total cost-threshold cost-self-funded cost-cost overrun) *(75+ age *0.2)%. In general, the actual reimbursement rate ranges from 20% to 60%. Self-funded drugs are not reimbursed, 80% of Class B drugs are reimbursed, bed fees are limited, and some inspection fees and medical treatment fees according to regulations cannot be reimbursed.

2. The reimbursement amount of medical insurance card is 4 times of the average salary of local social workers (1 year cumulative value).

3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.

4, serious illness insurance reimbursement insured suffering from a serious illness, in the city's medical insurance designated medical institutions, in line with the provisions of the city's medical insurance personal responsibility, into the scope of payment of residents' serious illness insurance, 50% reimbursement by the serious illness insurance fund. That is, reimbursement amount = self-funded part ×50% four. The proportion of medical insurance card reimbursement Ministry of Human Resources and Social Security announced the 13th Five-Year Plan for the Development of Human Resources and Social Security in July this year. China should stabilize the proportion of hospitalization expenses in the basic medical insurance policy for employees and urban and rural residents at around 75%.

Two, the difference between medical insurance account and individual account:

1. Different functions:

The overall account is mainly used for reimbursement of medical expenses such as hospitalization, referral from different places, outpatient chronic diseases or special diseases; Personal accounts are mainly used for small expenses other than medical insurance reimbursement, such as buying medicines at designated pharmacies, seeing doctors in outpatient clinics, and reimbursing expenses.

2. Gold is different:

Part of the funds are transferred to the overall account, and a small part of the funds are transferred to the individual account. The allocation ratio of pooling accounts and personal accounts of different employees' medical insurance in different places is also different, and the scope of use of personal accounts is also different.

3. The extraction amount of gold is different:

You can't withdraw money from the overall account, but you can withdraw money from the personal account. If the insured person dies or emigrates, or leaves his job or is transferred from another place, he can apply to withdraw the money from the personal account of the medical insurance card.

Third, whether it is the money in the overall account or the money in the personal account, it can only be used for medical treatment and cannot be used for daily consumption.

1. Personal account is used for: outpatient and emergency medical expenses; The cost of purchasing drugs at designated retail pharmacies; Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund; Medical expenses that exceed the qifubiaozhun of the basic medical insurance pooling fund and should be borne by individuals in proportion.

2. Overall account: hospitalization expenses; Emergency rescue observation and income hospitalization, medical expenses within 7 days before hospitalization observation; Outpatient medical expenses of taking anti-rejection drugs after radiotherapy and chemotherapy, renal dialysis and renal transplantation for malignant tumors.

3. In social security, the unit payment part and the individual payment part are divided. The unit payment will enter the overall account and the individual payment will enter the personal account. For example, the pension insurance unit pays 20% of the employee's salary and enters the personal account. In medical insurance, part of the company's payment will be left in the employee's personal account (according to different local rules).

The money in the personal account belongs to the individual. In the old-age insurance, if an employee dies before retirement age, the personal account of the old-age insurance will be returned to the beneficiary. The money in the personal account of medical insurance is for personal use, which can pay the outpatient expenses, the personal self-paid part of social security medical care, and buy medicines. , the overall account belongs to * * *.

legal ground

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

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.