Social security card or medical insurance card for hospitalization reimbursement?

The medical insurance card is used for hospitalization reimbursement. Medical insurance refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance card can be used for our usual medical treatment and hospitalization reimbursement, while the social security card also includes other insurances such as endowment insurance and cannot be used for medical reimbursement.

Medical insurance card reimbursement is determined according to the situation. There are two medical insurance card accounts, one is personal account and the other is overall account. In the case of overall planning, after the overall planning account is reimbursed according to the corresponding proportion, the remaining medical expenses after deducting the medical insurance reimbursement part can be deducted from the personal account balance.

Medical insurance card reimbursement scope:

1. The reimbursement of medical insurance card is limited to the medical expenses above hospitalization in the re-designated hospital due to illness and some accidents. The reimbursement formula is: (total expense-threshold expense-self-expense-expense overrun) *(75+ age *0.2)%.

In general, the actual reimbursement rate ranges from 20% to 60%.

Self-funded drugs are not reimbursed, class B drugs are reimbursed 80%, bed fees are limited, and some inspection fees and treatment fees are not reimbursed according to regulations.

2. The reimbursement amount of medical insurance card is 4 times of the local social wage (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.

Legal basis:

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

Article 28

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

The medical expenses of the insured shall be paid by the basic medical insurance fund, and 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.