Description of reimbursement scope and proportion process of rural medical insurance in Beijing in 2023 (latest edition)

Now many people in Beijing are paying social security and medical insurance. I believe many people still can't tell the difference between rural medical insurance and social security. Rural medical insurance is an important part of China's social security and an affordable policy for farmers to enjoy rural medical insurance. But social security is for urban workers or freelancers with urban hukou. So what is the scope of reimbursement for rural medical insurance in Beijing? What is the proportion and process of reimbursement for rural medical insurance in Beijing? I sorted out the relevant knowledge of rural medical insurance in Beijing for reference!

1, drug costs, artificial organs;

2. Hospital bed fee;

3. Hospitalization expenses, treatment expenses and rescue expenses;

4. Hospitalization expenses;

5, hospital laboratory fees, inspection fees, guardianship fees;

6. Hospitalization physiotherapy fee and delivery fee;

7. Medical expenses and nursing expenses;

8, outpatient special diseases:

(1) radiotherapy and chemotherapy for tumors;

(2) uremic renal dialysis;

(3) Take anti-rejection drugs after kidney transplantation and liver transplantation.

9. Treatment fees, physiotherapy fees, laboratory fees, inspection fees, radiation fees, operation fees, rescue fees and guardianship fees for general outpatient clinics and large outpatient clinics;

10, blood transfusion fee;

1 1, medical expenses and treatment expenses.

Beijing rural medical insurance is not reimbursed.

1, expenses incurred in non-designated for-profit medical institutions;

2 expenses incurred in non-medical insurance designated medical institutions;

3, the cost of staying in the special needs ward;

4, due to suicide, self-mutilation, alcoholism, drug abuse, smoking cessation, alcohol withdrawal, Internet addiction treatment and other expenses;

5, infertility, pregnancy test, childbirth, family planning surgery, IVF and other expenses;

6, animal injury, vaccination, physical examination, beauty, plastic surgery and other expenses;

7, fighting, fighting, drug abuse and other illegal expenses;

8. Traffic accidents, industrial accidents, medical accidents and other liability accidents;

9, statutory occupational disease treatment costs;

10, treatment expenses abroad, Hong Kong, Macao and Taiwan;

1 1, other expenses that should be paid by individuals according to the relevant provisions of the state and this Municipality.

Proportion of reimbursement for rural medical insurance in Beijing

1. The general outpatient department approved medical expenses, and the first-class hospital reimbursed 50%, the second-and third-class hospitals reimbursed 35%, and the district Chinese medicine hospital reimbursed 40%. The actual reported funds were capped at 2,500 yuan.

2, hospitalization and special disease outpatient reimbursement

1 designated first-class and second-class hospitals with 0 deductible line, and tertiary hospitals with 0/000 yuan deductible line. The upper limit of actual reported funds is 6,543,800 yuan+0.8 million yuan.

2 designated secondary medical institutions for hospitalization and special disease outpatient service, approved the reimbursement of 0 to 20 thousand yuan of medical expenses, the reimbursement ratio is 65%; 20 thousand yuan to 50 thousand yuan, 70% reimbursement; More than 50,000 yuan, 75% reimbursement.

3, in the designated level of medical institutions hospitalization and special disease outpatient treatment, the medical expenses reimbursement of 70%.

4. The reimbursement rate of hospitalization and special disease outpatient medical expenses in designated tertiary medical institutions is lower than that in designated secondary medical institutions by 10 percentage point.

Reimbursement of rural medical insurance in Beijing

1, the cost of emergency without card;

2. Expenses incurred during the period of manual reimbursement for medical treatment;

3. After the social security card is lost, make up (replace) the medical expenses during the period of issuing the social security card;

4, the new insured, after the insured did not send social security card during the medical expenses;

5, in line with the provisions of medical insurance in other places of medical expenses.

Reimbursement materials for rural medical insurance in Beijing

1, social security card;

2. Detailed list of manual reimbursement expenses for basic medical insurance for urban residents in Beijing;

3. Audit Form for Manual Reimbursement of Basic Medical Insurance for Urban Residents in Beijing;

4. Charge bills;

5, discharge diagnosis certificate;

6, hospitalization expenses list (or summary list);

7 proof of full settlement (except for off-site expenses and newborn expenses);

8. Offer documents;

9, emergency observation, outpatient special diseases, family beds to provide prescriptions, cost details;

10, the Beijing Medical Insurance Referral (Hospitalization) Form is required for referral treatment;

1 1, a copy of Beijing social security card issuance receipt or a copy of Beijing social security card business receipt or a copy of the new social security card certificate;

12, the description of trauma is stamped with the official seal of the Social Security Office;

13. A copy of the birth medical certificate is required for the newborn.

Reimbursement process of rural medical insurance in Beijing

1. The social security office receives the medical expense documents declared by the insured, inputs the medical expense information through the collection software, keeps the social security card, and submits the social security card and the declaration materials to the district (county) medical insurance agency in time;

2, the district (county) medical insurance agencies to complete the audit and settlement work in a timely manner;

3. The social security office shall promptly notify the insured person to retrieve the social security card and reimbursement results that have been audited and settled;

4. Distribute the Approval Form for Manual Reimbursement of Basic Medical Insurance for Urban Residents in Beijing, the Audit Form for Manual Reimbursement of Basic Medical Insurance for Urban Residents in Beijing, and the Detailed Table for Settlement and Payment of Manual Reimbursement of Basic Medical Insurance for Urban Residents in Beijing.