Social security can not reimburse what medical

Continuous payment meets the local health insurance reimbursement standards, hospitalization can enjoy reimbursement. Just bought is not possible, the normal need to contact the payment of more than 3 months level can be.

2. If you have a health insurance card, then the ordinary outpatient, designated pharmacies to buy drugs can be swiped to spend (provided that the card to have money Oh, the money in the card is the part of the individual contributions and unit contributions allocated to the individual's portion)

3. Ordinary illnesses, it is necessary to have a hospitalization, and the related costs more than the number of the starting point of the cost can be reimbursed

4. In addition to purchase a large medical insurance, according to the general medical reimbursement after the remaining part of the reimbursement can be declared large medical insurance reimbursement, detailed specific regulations, each place some similar, specific can ask the local social security institutions.

Expanded Information

Medical Reimbursement

I. Outpatient

(1) The use of the medical insurance card to the outpatient clinic, real-time settlement, without reimbursement.

(ii) If you visit the outpatient clinic without a medical insurance card, please use the Beijing Medical Insurance Handbook (medical blue book).

Social security reimbursement 1. Reimbursement scope: general outpatient and emergency expenses incurred by insured persons at the medical insurance designated hospitals or specialized hospitals of their choice, Chinese medicine hospitals and Class A hospitals.

2. Outpatient starting line: the total amount of general outpatient and emergency expenses incurred in a natural year exceeds 1,800 yuan.

3. Reimbursement rate: 70% for hospitals and 90% for communities for the portion above 1800 yuan, and the ceiling line: 20,000 yuan.

4. Required materials:

Original ID card;

Original medical diagnosis certificate;

Original medical documents such as outpatient medical records, report cards of examination and test results;

Original receipts of fees for general outpatient services and emergency services,

Original list of outpatient expenses or original prescriptions (the prescriptions are pasted on the back of the receipts according to the date). ).

5. Submission time: 1-10th of each month, the current month's fees to be submitted the following month, the current year's fees need to be submitted by January of the following year.

6. Process: if the total amount exceeds the starting standard in a natural year, the unit operator will enter all the documents into the enterprise version of the software, and report the generated electronic information and statements to the medical insurance center, which will complete the audit, settle the accounts, and pay the reimbursement fees within 30 working days.

II. Hospitalization

1. Reimbursement scope: hospitalization expenses incurred by insured persons at the designated hospitals or specialized hospitals of medical insurance of their choice, Chinese medicine hospitals and Class A hospitals.

2. Starting line for hospitalization: the starting line for the first hospitalization in a natural year is 1,300 yuan, and 650 yuan for each subsequent hospitalization.

3. Reimbursement rate: 90% for Class I hospitals, 87% for Class II hospitals, 85% for Class III hospitals, and a cumulative reimbursement of 300,000 yuan for hospitalization.

4, the process: please use the "Beijing Municipal Health Insurance Handbook" when seeking medical treatment, if the unit pays in full, the individual only needs to pay part of the hospitalization advance payment, you can go through the hospitalization procedures, the medical expenses incurred should be in line with the scope of medical insurance, the hospital and the individual to clear the amount of out-of-pocket expenses when the hospital is discharged, and the amount of reimbursement of the integrated fund will be settled by the hospital and the district health insurance center.

Maternity reimbursement

I. Maternity allowance

1. Required documents:

Original and copy of Marriage Certificate;

Original and copy of Maternity Service Certificate;

Original and copy of the birth certificate of the baby;

Original and copy of the medical certificate;

Original and copy of the medical certificate.

Two copies of "Beijing Maternity Allowance Applicant Information Registration Form" (must be filled in with a black signature pen).

Note: The above copies must be on A4 paper.

2. Submission time: 1-10th of each month (2 months after the baby's birth).

3, the process: the unit operator with the above materials reported to the social security center, acceptance and approval of 30 working days after the payment of maternity allowance costs.

If you are eligible to enjoy the reward allowance for late childbearing (at the age of twenty-three), both husband and wife should choose the object of enjoying the allowance for late childbearing in the "Beijing Municipal Maternity Allowance Claims Information Registration Form" and both husband and wife should sign to confirm it and have it stamped by the units of both parties.

If both spouses have joined the maternity insurance, the woman's unit shall fill in the "Beijing Maternity Allowance Recipients Information Registration Form"; if the woman has not joined the maternity insurance and the man has joined the maternity insurance, and the man is entitled to the late-birth allowance, the man's unit shall fill in the "Beijing Maternity Allowance Recipients Information Registration Form" (in duplicate) and carry out the declaration work.

Two, maternity medical expenses (prenatal checkup)

1, the required materials:

Original and copy of the Certificate of Maternity Service;

Copy of the baby's birth certificate;

Copy of the medical diagnostic certificate;

Original copies of all the receipts and prescriptions (for Chinese and Western medicines), organized in order of the date. One copy of "Beijing Maternity Insurance Manual Reimbursement Declaration Form for Medical Expenses" (must be filled in with a black signature pen).

2. Submission time: 1-10th of each month (2 months after the baby's birth).

3, the process: the insured unit operator with the above materials reported to the Social Security Center, acceptance and approval of 30 working days after the payment of maternity medical (prenatal checkups).

Third, family planning surgery medical expenses (hospitalization fees)

1, the required materials:

Original and photocopy of the Certificate of Maternity Service;

A photocopy of the baby's birth certificate;

A photocopy of the medical diagnostic certificate;

All the receipts, prescriptions (Chinese and Western medicines fees), and the detailed list of hospitalization fees, The originals of the hospitalization settlement list, organized in the order of date (4 RMB for consultation fee can be reimbursed);

One copy of "Beijing Maternity Insurance Manual Reimbursement of Medical Expenses Declaration Form" (must be filled in with a black signature pen).

2. Submission time: 1-10th of each month (2 months after the birth of the baby for processing).

3, the process: unit operator with the above materials on the 1st-20th of each month to report to the Social Security Center, acceptance and approval of 30 working days after the payment of medical expenses for family planning surgery.

Work injury reimbursement

1, the required materials:

"Work Injury Recognition Application Form" in four copies, photocopying is invalid;

"Diagnostic Certificate" and outpatient (inpatient) cases or "Occupational Disease Diagnostic Certificate" in the original and a copy of a copy;

the text of the labor contract in the original and a copy of a copy;

Injured person A copy of ID card;

2. Submission time: 1-10th of each month

3. Process:

Application: the unit operator reports to the social security center with the above materials;

Acceptance: the Work Injury Determination Section examines the application within 15 days after receiving the application, and accepts the application if it meets the conditions, and informs the unit operator to make up for the materials within

Identification: the review meets the conditions for identification within 60 days (extended for another 30 days in special circumstances) to make notification of the conclusion of the determination of work-related injuries and inform the unit operator, not meet the conditions for identification of the unit operator informed of the identification of work-related injuries recognized as a work-related injuries issued work-related injuries;

Appraisal: the period of leave without pay or treatment of injuries are basically stabilized, the applicant to the Labor Capacity Appraisal Committee for the evaluation of labor capacity.

Workers' Compensation: If the applicant meets the conditions for enjoying the work injury insurance treatment after appraisal, the unit operator will apply to the social security center for treatment review, and according to the approved treatment, the social security center will pay the treatment to the injured worker within the specified time.

Extended reading: how to buy insurance, which is good, hand to hand to teach you to avoid the insurance of these "pits"