Job Recruitment Website - Social security inquiry - Can I still report the money in the employee's medical insurance after I run out?
Can I still report the money in the employee's medical insurance after I run out?
The money in the medical card belongs to the balance of the personal account of medical insurance, which is mainly used for personal expenses such as outpatient medicine purchase and payment, which are two different things from medical insurance reimbursement.
The proportion of reimbursement for outpatient medical insurance for employees is as follows:
1. The proportion of medical insurance reimbursement for employees is divided according to the actual medical expenses incurred by the insured. Usually, the lowest reimbursement rate for hospitalization is 85%, and the highest reimbursement rate is 95%; The proportion of medical insurance reimbursement for urban and rural residents is between 50% and 80% according to the hospital level. Due to the different economic levels in different regions, the proportion of medical reimbursement may be slightly different;
2, medical insurance card reimbursement is generally proportional, generally 60%-70%. In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The minimum threshold of tertiary hospitals is 659 yuan, and the upper limit of reimbursement ratio is 2000 yuan. The minimum threshold for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%. There is no minimum threshold for first-class hospitals.
Medical insurance reimbursement process:
1. Confirm reimbursement scope: During the treatment, you need to confirm whether your treatment items are within the scope of medical insurance reimbursement;
2. Collect reimbursement materials: collect relevant treatment records, drug receipts, medical expense lists and other relevant materials;
3. Go to the social security department for reimbursement: submit relevant materials for medical insurance reimbursement to the local social security department;
4. Pending review: The social security department will conduct relevant review and comparison to confirm the reimbursement ratio and reimbursement amount; Receive reimbursement: After approval, you can receive medical insurance reimbursement at the designated bank.
To sum up, the expenses in the medical insurance card are the expenses in our personal account, and the reimbursement of the medical insurance card is the reimbursement of China as a whole. The payment of this co-ordination fee is paid by the enterprise, and China jointly contributes to the medical insurance reimbursement. So it doesn't matter if we don't have money in our medical insurance card, it won't affect our reimbursement, but we don't have the money to go to the outpatient clinic to register and buy medicine at the pharmacy.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
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.
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