Binjiang social security center medical insurance reimbursement

Social security reimbursement refers to the behavior of social insurance to compensate employees and residents for medical expenses, maternity expenses and work-related injury treatment expenses in proportion. Social security reimbursement mainly includes maternity insurance reimbursement and work-related injury insurance reimbursement. The reimbursement methods of social medical insurance vary from place to place.

Procedures required for social insurance reimbursement:

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.

Maternity leave reimbursement

I. Maternity allowance

1, required materials:

One original and one copy of the marriage certificate;

One original and one copy of the Maternity Service Certificate;

One original and one copy of the baby's birth certificate;

One original and one copy of the medical diagnosis certificate;

"Maternity Allowance Applicant Information Registration Form" in duplicate (filled in with black pen).

Note: The above copies must be on A4 paper.

2. Submission time: every month 1- 10 days (2 months after the baby is born).

3. Handling process: the unit manager will submit the above materials to the social security center, and pay the maternity allowance within 30 working days after accepting the approval.

In line with the conditions for enjoying the late childbirth (over 23 years old) incentive allowance, both husband and wife choose the object to enjoy the late childbirth allowance in the Information Registration Form of Persons Applying for Maternity Allowance in Beijing, which is signed and confirmed by both husband and wife, and sealed by both parties.

If both husband and wife have participated in maternity insurance, the woman's unit shall fill in the Information Registration Form for Persons Applying for Maternity Allowance in Beijing; If the woman has not participated in maternity insurance, and the man has participated in maternity insurance, and the man enjoys maternity allowance, the unit where the man works shall fill in the Information Registration Form for Persons Applying for Maternity Allowance in Beijing (in duplicate) and make a declaration.

Two, maternity medical expenses (prenatal examination)

1, required materials:

One original and one copy of the Maternity Service Certificate;

A copy of the baby's birth certificate;

Copy of medical diagnosis certificate;

All original receipts and prescriptions (Chinese and western medicine fees) are sorted out smoothly according to the date (medical expenses can be reimbursed to 4 yuan);

Application Form for Manual Reimbursement of Maternity Insurance Medical Expenses (filled in with black signature pen).

2. Submission time: every month 1- 10 days (2 months after the baby is born).

3. Handling process: the manager of the insured unit submits the above materials to the social security center, and pays the maternity medical (prenatal examination) fee within 30 working days after accepting the examination and approval.

Three, family planning surgery medical expenses (hospitalization)

1, required materials:

One original and one copy of the Maternity Service Certificate;

A copy of the baby's birth certificate;

Copy of medical diagnosis certificate;

All receipts, prescriptions (Chinese and western medicine fees), details of hospitalization expenses and original hospitalization settlement list are sorted in chronological order (medical expenses can be reimbursed to 4 yuan);

Application Form for Manual Reimbursement of Maternity Insurance Medical Expenses (filled in with black signature pen).

2. Submission time: every month 1- 10 days (2 months after the baby is born).

3. Handling process: the unit manager submits the above materials to the social security center on June 5438+0-20 every month, and pays the medical expenses for family planning surgery within 30 working days after accepting the approval.

Industrial injury compensation

1, required materials:

The application form for work-related injury identification is in quadruplicate, and the copy is invalid;

One original and one copy of the diagnosis certificate and the diagnosis certificate of outpatient (inpatient) cases or occupational diseases;

One original and one copy of the text of the labor contract;

Copy of the injured person's ID card;

2. Submission time: 1- 10 days per month.

3. Processing flow:

Application: the unit manager submits the above materials to the social security center;

Acceptance: the work-related injury identification department will review the application within 15 days after receiving it. Those who meet the conditions should be admitted. If the application materials are incomplete, inform the unit manager to fill in the materials within 30 days;

Appraisal: within 60 days after the examination (extended for another 30 days under special circumstances), make a notice of work-related injury appraisal conclusion and inform the person in charge of the unit, inform the person in charge of the unit if it does not meet the appraisal conditions, and issue a work-related injury certificate for the work-related injury;

Appraisal: If the work stoppage expires or the injury is basically stable after treatment, the applicant shall submit the labor ability appraisal to the labor ability appraisal committee to assess the disability level;

Work-related injury insurance benefits: If it is qualified to enjoy work-related injury insurance benefits after appraisal, the unit manager will apply to the social security center for review of benefits, and the social security center will pay the benefits to the workers with work-related injuries within the specified time according to the approved benefits.

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