Can Beijing Social Security reimburse medical treatment in different places?

According to the relevant regulations issued by Beijing Medical Insurance Affairs Management Center in 2020, Beijing medical insurance can be reimbursed for medical treatment in different places.

Social insurance refers to a social and economic system that provides income or compensation for people who lose their ability to work, are temporarily unemployed or suffer losses due to health reasons. The main items of social insurance include endowment insurance, medical insurance, unemployment insurance, industrial injury insurance and maternity insurance.

The social insurance plan is organized by the government, forcing a certain group to use part of its income as social insurance tax (fee) to form a social insurance fund. Under certain conditions, the insured can get fixed income or loss compensation from the fund. It is a redistribution system, and its goal is to ensure the reproduction of material and labor and social stability.

In China, social insurance is an important part of the social security system, occupying a core position in the whole social security system. In addition, social insurance is a contributory social security. The funds are mainly paid by employers and workers themselves, and the government finances give subsidies and bear the ultimate responsibility. However, workers can only enjoy the corresponding social insurance benefits if they fulfill their statutory payment obligations and meet the statutory conditions.

There are two kinds of social security, the first is employee social security, which is also commonly known as five insurances. Including medical insurance, endowment insurance, maternity insurance, unemployment insurance and industrial injury insurance. Second, social security for residents, including medical insurance and endowment insurance, such as endowment insurance for urban and rural residents and medical insurance for urban and rural residents.

Medical insurance in social security can reimburse medical expenses incurred by general medical care; Endowment insurance, you can receive pension after retirement; The biggest function of maternity insurance is to reimburse the cost of giving birth to a baby and receive maternity allowance when taking maternity leave; Work-related injury insurance can reimburse expenses incurred due to work-related injuries; Finally, unemployment insurance, medical insurance during unemployment can be reimbursed for normal medical treatment without paying. Individuals sign agency contracts with human resources agency companies, submit relevant materials, and pay social security fees and service fees. (Social insurance premium: composed of enterprise payment part and individual payment part), which is purchased by the unit to which the individual belongs, and the total social insurance premium is paid by the individual. The agency pays social security fees for individuals on a monthly basis. Individuals can inquire about the details of the social security they have purchased and get the social security card the following month (before). People who need to buy social security from affiliated units: freelancers, entrepreneurs, flexible employees, temporarily unemployed or short-term workers.

What's the difference between social security bought by individuals and that bought by companies?

The insurance scope of the two is different: employee social security is what we usually call five insurances and one gold, which generally includes endowment insurance, medical insurance, work injury insurance, unemployment insurance and maternity insurance. Among them, only old-age medical care and unemployment insurance require individual contributions, and the rest are paid by enterprises. Flexible employment insurance generally has only three insurances, namely, endowment insurance, medical insurance and unemployment insurance. There is no industrial injury insurance and maternity insurance. Both of them determine the payment base according to the average social wage of last year, but most of the social security expenses of urban workers' social security are borne by the company, and the proportion of individual contributions is generally about 10% of wages. However, because there is no company to bear the cost, the proportion of flexible employees can reach about 20% of the payment base.

Legal basis:

Notice on Issues Concerning Direct Settlement of Medical Expenses for Inter-provincial General Outpatient (Emergency) Consultation Article 2 Relevant Issues Concerning Direct Settlement of Outpatient of Insured Persons in Different Places

(a) the insured person in the city outpatient direct settlement for medical treatment, in accordance with the relevant provisions of the insured area in advance or not for outpatient direct settlement filing procedures.

(two) the insured can directly settle the outpatient medical expenses settled by the designated medical institutions in this Municipality, and implement the payment scope and relevant regulations of Beijing basic medical insurance (basic medical insurance drug list, medical service facilities and diagnosis and treatment items); Policies such as minimum payment standard, payment ratio and maximum payment limit of medical insurance fund shall be implemented for the insured.

(three) the insured in the city outpatient medical treatment to implement the relevant procedures of the designated medical institutions in the city direct settlement. When registering for medical treatment, you need to take the initiative to show your social security card and seek medical treatment under your real name.

(4) When the insured person directly settles the outpatient service, he only needs to settle the expenses that should be borne by the individual with the designated medical institution, which belongs to the expenses paid by the medical insurance fund, and then settle with the designated medical institution after being audited by the medical insurance agency under the jurisdiction of the designated medical institution; The medical expenses settled in full by the insured for some reason shall be reimbursed manually to the insured place according to the original prescribed process.