Private clinic if you want to be able to reimburse the medical insurance, how to do the procedures, where to do it?

Hello, private clinics can be reimbursed for medical insurance, to do the procedures in the social security bureau, go to the social security bureau to do

A, medical insurance reimbursement scope

Not all costs can be reimbursed by the medical insurance, want to understand the medical insurance reimbursement rate, first of all, you should be clear about the scope of the reimbursement of the medical insurance

1. Starting line, the ceiling line

Starting line: outpatient or hospitalization costs need to reach a certain amount of money to be available to reimbursement of the medical insurance.

The threshold for outpatient and hospitalization expenses varies from region to region, and even from hospital to hospital in the same region.

Capping line: The upper limit of reimbursement for outpatient or inpatient costs is the cap.

The ceiling varies from region to region and from hospital to hospital.

2. Out-of-pocket expenses and co-payments

Out-of-pocket expenses: The portion of expenses that cannot be reimbursed under the medical insurance catalog.

Out-of-pocket expenses:All the expenses outside the medical insurance catalog, such as imported drugs, targeted drugs, etc. The starting line is also part of the out-of-pocket expenses.

3. The medical insurance reimbursement part

The medical insurance can only reimburse the outpatient and inpatient medical expenses within the medical insurance catalog.

There are three catalogs in the medical insurance catalog, namely, the Drug Catalog, the Diagnostic Program Catalog, and the Medical Service Facility.

Last year, the state made changes to the Drug List to expand the scope of reimbursement.

Take Beijing as an example:

1. Outpatient expenses

The following are the reimbursement rates for outpatient expenses in Beijing, including the type of hospital, the starting line, and the reimbursement rate.

Note: Beijing employees need more than 1800 yuan to reimburse the outpatient clinic, preferring the city's community hospitals, the reimbursement rate is higher than that of non-community hospitals, rather than going to the big hospitals on purpose.

As an example:

Zhang's doctor, who had previously met the threshold, spends 3,000 RMB on this outpatient visit, with an out-of-pocket payment of 800 RMB and a co-payment of 1,000 RMB, and is able to reimburse him with the health insurance for the amount of:

(3,000 - 800 - 1,000) x 90% = 1,080 RMB

Zhang will need to pay 1,920 RMB.

If you are hospitalized for a medical condition (tertiary hospital) and spend 20,000 yuan on a ****, with 8,000 out-of-pocket expenses and 5,000 out-of-pocket expenses, the amount that can be reimbursed with your health insurance is:

(20,000-1,300-8,000-5,000) × 85% = 5,700 yuan

You will also have to pay 14,300 yuan for your medical condition.

The above figures are for reference only, and the exact amount of reimbursement needs to be calculated according to the actual situation.

After the basic medical insurance is finished, if you are eligible for reimbursement from the major medical insurance, you can enjoy the policy of reimbursement from the major medical insurance for reimbursement.

Since January 12, 2016, the State Council issued the "Opinions on the Integration of Urban and Rural Residents' Medical Insurance System", the localities have been merged one after another, and the urban residents' medical insurance and the New Rural Cooperative have been merged into the urban and rural residents' medical insurance.

The urban and rural residents' health insurance only needs to pay a few hundred dollars a year, which is much cheaper than the employee health insurance, so the standard of treatment is generally lower than the employee health insurance.

The employee health insurance can choose more designated hospitals, high reimbursement rate, usually in the 70% -90%, the reimbursement limit of about 20-50 million.

The reimbursement rate for urban and rural residents is low, mostly 40%-70%, and the reimbursement limit is around 100,000-200,000 RMB.