How to reimburse social medical insurance?

In practice, there are many kinds of medical insurance, and social medical insurance is one of them. The main purpose is to give appropriate subsidies or reimbursement for medical expenses needed by workers when they are sick, so that workers can recover their health and labor ability as soon as possible and enter the process of social reproduction. First, how to reimburse social medical insurance The reimbursement ratio of medical insurance in different hospitals is different: if a person spends 10000 yuan in a hospital, if he is hospitalized in a first-class hospital, then 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you will be reduced by 2000 yuan first; After excluding "non-medical insurance drug expenses" and "other non-medical insurance expenses", the remaining employees reported 80%, retired or unemployed, and unemployed 50%. (Note: Medical insurance reimbursement only covers Class A drugs, that is, medical insurance drugs, while Class B is non-medical insurance and cannot be reimbursed. ) The proportion of on-the-job employees' hospitalization reimbursement is medical insurance hospitalization. Except for the self-funded part and self-funded 10%, the part exceeding the hospital medical insurance deductible line enjoys the proportion of overall payment. Different levels of hospitals have different deductible lines and different proportions of overall payment. The proportion of medical insurance for employees is over 80% (82%/84%/87% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan). The social security card has not adjusted any medical reimbursement ratio. According to the Regulations of Beijing Municipality on Basic Medical Insurance issued in 2005, the social supplementary medical insurance for retirees under 70 years old is 50%. Payment institutions need to prepare copies of medical insurance manuals, medical bills, receipts and details when handling reimbursement procedures. For details, please also consult the labor security telephone number 12333. 2. Social medical insurance reimbursement information 1, original ID card or social security card; 2, the original certificate of disease diagnosis issued by the designated medical institutions; 3, outpatient medical records, inspection, test results report and other original medical information; 4. Original receipt of outpatient charges of medical institutions with unified finance and taxation; 5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors; 6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods; 7. If it is an agent, you need to provide the original ID card of the agent. Third, the reimbursement rate of social medical insurance is 1, the reimbursement rate of outpatient village clinics and village center clinics is 60%, the prescription drug fee limit for each visit is 10 yuan, and the prescription drug fee limit for temporary rehydration of doctors in health centers is 50 yuan; 40% reimbursement for medical treatment in the town health center, the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drugs is 100 yuan; Second-level hospitals will be reimbursed 30% for medical treatment, with each examination fee and operation fee limited to 50 yuan and prescription drug fee limited to 200 yuan; Third-level hospitals will be reimbursed 20% for medical treatment. The examination fee and operation fee for each visit are limited to 50 yuan, and the prescription drug fee is limited to 200 yuan; Chinese medicine invoice with prescription, each paste limit 1 yuan; The annual compensation limit for rural cooperative medical clinics is 5000 yuan. 2. Reimbursement scope of hospitalization: drug expenses: auxiliary examination: 200 yuan for various examination expenses such as electrocardiogram, X-ray fluoroscopy, photography, laboratory test, physiotherapy, acupuncture, CT and nuclear magnetic resonance; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). The elderly over 60 years old are hospitalized in health centers, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan. Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%. 3. For seriously ill inpatients participating in the cooperative medical system, the medical expenses should be more than 5,000 yuan at one time or throughout the year, that is, 500 1- 10000 yuan is 65%, and1-18000 yuan is 70%. The annual compensation limit of town-level cooperative medical system hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy is 1. 1 ten thousand yuan. 4. Exemption from self-seeking medical treatment (no designated hospital for medical treatment or no referral form), self-purchased drugs, drugs that cannot be reimbursed according to the provisions of free medical care, and medical expenses that do not meet family planning; Outpatient treatment fee, visiting fee, hospitalization fee, meals fee, escort fee, nutrition fee, blood transfusion fee (except for family blood storage, which shall be reimbursed according to relevant regulations), cooling and heating fee, ambulance fee, special nursing fee, etc. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents; Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ; Within the scope of reimbursement, beyond the limit. I hope the above information about how to reimburse social medical insurance, the information needed for reimbursement of social medical insurance and the proportion of reimbursement of social medical insurance will be helpful.

Legal objectivity:

Social medical insurance means that when workers get sick, social insurance institutions give appropriate subsidies or reimbursement for their medical expenses, so that workers can recover their health and labor ability as soon as possible and enter the process of social reproduction. Social medical insurance is an important part of social insurance, which is generally borne by the government. The government will use economic, administrative and legal means to implement and organize. So how to reimburse the insured's medical expenses? Medical insurance is divided into two accounts, personal account and medical insurance card. The money can be used to buy medicines at designated pharmacies, pay outpatient expenses and pay the part of hospitalization expenses that individuals pay. The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account. When seeking medical treatment (hospitalization), show the medical insurance card to the designated hospital to prove the identity of the insured. At the time of checkout, the part paid by the individual is paid by medical insurance card or cash, and the part reimbursed by medical insurance is settled by medical insurance and hospital, so the individual does not need to pay first and then reimburse. Medical expenses of outpatients cannot be reimbursed. How to reimburse social medical insurance Different hospitals have different reimbursement rates for medical insurance: If a person spends 10000 yuan in a hospital, if he is hospitalized in a first-class hospital, then 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you will be reduced by 2000 yuan first; After excluding "non-medical insurance drug expenses" and "other non-medical insurance expenses", the remaining employees reported 80%, retired or unemployed, and unemployed 50%. (Note: Medical insurance reimbursement only covers Class A drugs, that is, medical insurance drugs, while Class B is non-medical insurance and cannot be reimbursed. ) The proportion of on-the-job employees' hospitalization reimbursement is medical insurance hospitalization. Except for the self-funded part and self-funded 10%, the part exceeding the hospital medical insurance deductible line enjoys the proportion of overall payment. Different levels of hospitals have different deductible lines and different proportions of overall payment. The proportion of medical insurance for employees is over 80% (82%/84%/87% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan). The social security card has not adjusted any medical reimbursement ratio. According to the Regulations of Beijing Municipality on Basic Medical Insurance issued in 2005, the social supplementary medical insurance for retirees under 70 years old is 50%. Payment institutions need to prepare copies of medical insurance manuals, medical bills, receipts and details when handling reimbursement procedures. For details, please also consult the labor security telephone number 12333. Matters needing attention 201265438+129 October Business, the development plan of urban and rural economic and social integration during the Twelfth Five-Year Plan period was announced. In 20 15, Beijing will establish an urban-rural integrated industrial injury and maternity insurance system. Explore the inclusion of members of rural cooperative organizations, township entrepreneurs and flexible employees in the industrial injury insurance system. The city will also increase the overall planning of urban and rural subsistence allowances, gradually improve the level of subsistence allowances, narrow the gap between urban and rural areas, and effectively protect the basic livelihood of low-income groups.