Reimbursement ratio of Ningbo medical insurance new policy

Legal analysis: 1. Reimbursement materials: 1. Medical insurance stamped "Zhejiang provincial retirees outpatient emergency medical expenses application and funding table", effective medical expenses receipt, medical expenses detailed list, medical certificate calendar. Second, the reimbursement process: Tips: The corresponding materials are fully prepared. After the approval, the social security card payment will be directly reimbursed. Outpatient reimbursement: bring information to the relevant departments of the local social security center to apply for it. The information is complete, and those who pass the examination shall be handled immediately. When applying for reimbursement of outpatient medical expenses, the applicant should first deduct the amount allocated to the personal account of medical insurance in this social security year, and then verify the amount to be reimbursed. Hospitalization reimbursement: 1. When entering or leaving the hospital, you must register with the medical insurance IC card at the medical insurance management window of each designated medical institution. Personal hospitalization should pay 2000 yuan in advance for medical expenses, and make up for it more or less after discharge. The medical expenses incurred before the hospitalization registration formalities shall not be included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, it should go through the hospitalization formalities at the medical insurance management window with the emergency certificate on the day after admission (holidays will be postponed). If it exceeds the time limit, the medical expenses shall be borne by itself. 2. After the insured is hospitalized, the deductible line of the overall fund is divided into three grades: tertiary hospital 1000 yuan, secondary hospital 600 yuan, and primary hospital 400 yuan. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively. 3, the insured due to illness need referral (hospitalization), shall be approved by the designated medical institutions (three or more) deputy chief physician or chief physician diagnosis put forward referral (hospitalization) opinions, by the unit to fill in the application form, after the approval of the designated medical institutions medical insurance management department reported to the municipal (District) social security institutions for referral (hospitalization) procedures. 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 reimbursement amount and the amount payable by individuals shall be calculated by the designated medical institutions, and the reimbursement amount shall be settled by the designated medical institutions and urban social insurance agencies, and the amount payable by individuals shall be settled by the designated medical institutions and the insured.

Legal basis: Article 28 of the Social Insurance Law stipulates that medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations. Article 29 of the Social Insurance Law stipulates that the part of the insured's medical expenses that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, 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.