How to reimburse Dongguan social security card for medical treatment?

Social security reimbursement is divided into medical insurance reimbursement, maternity insurance reimbursement and work-related injury insurance reimbursement, and the use of social security card reimbursement should refer to medical insurance reimbursement. Employees can be directly settled by medical insurance when they are treated in the hospital. If there is no direct settlement, the reimbursement process is as follows:

Medical reimbursement

I. Outpatient service

(a) the use of medical insurance card to outpatient treatment, real-time settlement, no reimbursement.

(2) Please use Beijing Medical Insurance Manual (medical blueprint) for outpatient treatment without medical insurance card.

1. Reimbursement scope: general outpatient and emergency expenses incurred by the insured in designated hospitals or specialized hospitals, traditional Chinese medicine hospitals and tertiary hospitals selected by individuals.

2. Outpatient deductible line: the total emergency expenses of general outpatient service exceed 1.800 yuan in a natural year.

3. Reimbursement ratio: 70% for the hospital, 90% for the community, and the top line: 20,000 yuan.

4, the required materials:

Original ID card;

Original medical diagnosis certificate;

Original medical data such as outpatient medical records, examination and test results reports;

Original receipt of general outpatient and emergency charges,

The original of the detailed list of outpatient expenses or prescription (the prescription is pasted on the back of the receipt by date).

5. Submission time: every month 1- 10, the expenses of the current month shall be submitted the next month, and the expenses of the current year shall be submitted before 1 the following year.

6. Handling process: If the accumulated Qifubiaozhun exceeds the Qifubiaozhun in a natural year, the unit manager will input all the documents into the enterprise software and report the generated electronic information and statements to the medical insurance center, which will complete the review, settlement and payment of reimbursement expenses within 30 working days.

Second, hospitalization.

1. Reimbursement scope: hospitalization expenses incurred by the insured in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by the individual.

2. Inpatient deductible line: The standard of the first hospitalization deductible line in a natural year is 1.300 yuan, with 650 yuan as the unit each time.

3. Reimbursement ratio: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total reimbursement of 300,000 yuan for hospitalization.

4. Handling process: Please use the Beijing Medical Insurance Manual for medical treatment. If the unit pays in full, the individual can go through the hospitalization formalities only by paying part of the hospitalization advance payment, and the medical expenses incurred should meet the scope of medical insurance. When leaving the hospital, the hospital and the individual will settle the expenses themselves, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.