Rural health insurance card reimbursement rate is how much

Medicare card to be reimbursed is to see the scope, in line with the scope and then in accordance with the proportion of reimbursement, which is necessary for us to understand the content.

One, the medical card reimbursement scope and proportion is how much

The urban residents of the basic medical insurance starting standard and reimbursement ratio in accordance with the category of the insured person to determine the different standards.

First, students and children. For medical expenses under 180,000 RMB that are eligible for reimbursement within a billing year, the starting standard is 500 RMB and the reimbursement rate is 55% for tertiary hospitals, 300 RMB and the reimbursement rate is 60% for secondary hospitals, and there is no starting standard for tertiary hospitals, and the reimbursement rate is 65%.

The second is for the elderly aged 70 or above. In a settlement year, the medical expenses of less than 100,000 yuan that meet the scope of reimbursement, the starting standard for third-level hospitals is 500 yuan, and the reimbursement rate is 50%; the starting standard for second-level hospitals is 300 yuan, and the reimbursement rate is 60%; and first-level hospitals don't have a starting standard, and the reimbursement rate is 65%.

Third, other urban residents. In a settlement year, incurred in line with the scope of reimbursement of medical expenses of less than 100,000 yuan, the starting standard for third-level hospitals 500 yuan, the reimbursement rate of 50%; second-level hospitals hospitalization starting standard 300 yuan, the reimbursement rate of 55%; first-level hospitals do not set the starting standard, the reimbursement rate of 60%.

Urban residents who are hospitalized for more than two times in one billing year will no longer be charged the starting standard fee from the second hospitalization. If they are transferred to another hospital or are hospitalized for more than two times, the difference will be made up in accordance with the starting standard of the hospital to which they are transferred or to which they are re-admitted.

Second, the medical insurance card reimbursement materials

The main materials needed to apply for reimbursement are: the original original charge data sheet; the original cost breakdown; the original copy of the outpatient medical record; the original diagnosis; the emergency hospitalization, you need to issue a certificate of hospitalization in an emergency; the original copy of the social security card; the original copy of the ID card (entrusted to another person to do the work on behalf of others should be provided with the identity documents of the person who did the work on behalf of others); A copy of the original bank account (passbook or bank card is fine); the original certificate of the organization (this is a specific document that some company employees need to provide for reimbursement, but most of the general employees do not need to provide it) and so on. After you have prepared the necessary documents for reimbursement, you can follow the reimbursement process of your local health insurance.

Three, the health insurance card reimbursement process is how

First of all, the applicant is required to apply for reimbursement, and then, to submit the reimbursement of the relevant application materials required to submit the materials in the place of the participant in the Social Security Fund Management Bureau of each sub-district of the Social Security Bureau of the health insurance section.

After receiving an application for reimbursement, the receiving department of the Administration will check the documents provided by the applicant within five days from the date of receipt of the documents and decide on the final acceptance result.

If the application materials are incorrect or incomplete, the receiving department will notify the applicant and tell him/her to prepare the required materials within 5 days and correct any errors in the materials.

Applicants are required to complete the corrections within 5 days from the date of receipt of the "Notice of Correction". If the deadline is exceeded, the application will not be corrected and will be withdrawn. If the corrections are completed within the deadline, the application can be resubmitted within the validity period of the Shenzhen health insurance reimbursement.

If the verification process is correct, the reimbursement application is complete and the applicant can be reimbursed after having received the Social Health Insurance Medical Expense Reimbursement Form.

The Social Insurance Law of the People's Republic of China (PRC) Article 25 of the PRC establishes and improves the basic medical insurance system for urban residents. Basic medical insurance for urban residents is a combination of individual contributions and government subsidies. The government shall subsidize the portion of individual contributions required by persons enjoying the minimum subsistence guarantee, persons with disabilities who have lost the ability to work, and elderly persons over the age of sixty and minors from low-income families. Article 26 The standards of treatment for basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations. Article 27 to participate in the employees' basic medical insurance individuals, reaching the legal retirement age, the accumulated contributions to the state prescribed number of years, after retirement, no longer pay the basic medical insurance premiums, in accordance with the provisions of the state to enjoy the basic medical insurance benefits; has not reached the state prescribed number of years, you can pay the contributions to the state prescribed number of years. Article 28 in line with the basic medical insurance drug list, diagnostic and treatment items, medical service facilities standards, as well as emergency, rescue medical expenses, in accordance with state regulations from the basic medical insurance fund. Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons. Article 30 of the following medical costs are not included in the basic medical insurance fund: (a) should be paid from the workers' compensation insurance fund; (b) should be borne by a third party; (c) should be borne by the public **** health; (d) outside the country for medical treatment. If the medical expenses should be borne by a third party in accordance with the law, and the third party does not pay or the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.