How to reimburse medical insurance when going to Beijing to see a doctor?

1. Reimbursement scope: general outpatient and emergency expenses incurred by the insured in designated medical insurance hospitals or specialized hospitals, traditional Chinese medicine hospitals and 3A hospitals (Friendship, Xuanwu, Guang 'anmen Traditional Chinese Medicine, Tongren, Sheikh, Beijing Third Hospital, Peking University People, Peking University First, Jishuitan, Chaoyang, Gong Jian and Liangxiang).

2. Reimbursement ratio: In a natural year, the average outpatient and emergency expenses incurred by on-the-job personnel total more than 2,000 yuan, and 50% of some large medical mutual funds with more than 2,000 yuan are paid, and 50% is paid by individuals. The retirees have accumulated more than 1.300 yuan, and the part that exceeds 1.300 yuan is covered by the large medical mutual aid fund over 70 years old, with 70% paid by individuals, 30% paid by individuals, 80% paid by the large medical mutual aid fund over 70 years old and 20% paid by individuals. The maximum payment limit in a natural year is 20000 yuan.

3. Medical management: individual cash payment for general outpatient and emergency expenses, and the medical expenses incurred meet the scope of the three major catalogues of medical insurance. When purchasing drugs, special prescriptions should be issued in designated hospitals and stamped with the special seal for medical insurance outsourcing, and then drugs should be purchased in designated pharmacies.

4. Reimbursement process: If the accumulated amount exceeds the minimum payment standard in a natural year, the insured shall submit the documents to the unit or social security office, which will enter the documents into the enterprise version and declare the electronic information and documents to the medical insurance center. The medical insurance center will complete the examination, settlement and payment within 15 working days.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.