What if the social security card can't be used?

Insurance Bian Xiao helps you answer, and more questions can be answered online.

One reason

The balance of the social security payment bank account is insufficient or the funds are not deposited into the account in time.

If the balance of the payment account is insufficient or the funds are not deposited in the account in time, so that the medical insurance fee cannot be withheld in full and on time, then the medical insurance benefits will be interrupted from the next month, which will affect the normal credit card settlement of the social security card.

In order not to affect the medical insurance benefits, all employers and flexible employees are required to deposit the funds in full into the social security payment account within the specified time.

It should be pointed out that:

Due to the arrears in the unit account, the medical insurance benefits of employees are interrupted, and the medical expenses incurred during the period cannot be applied for sporadic reimbursement, which should be paid by the employer with reference to the medical insurance benefits standard.

Unemployed people and flexible employees can apply for reimbursement after the interruption of medical insurance payment due to unpaid wages. After one-time repayment according to the payment standard at the time of repayment, the medical insurance benefits will be resumed from the next month. If the payment does not exceed 3 months, the medical expenses incurred during the interruption can be applied for sporadic reimbursement from the next month. If it has been more than 6 months or less, but they are unwilling to pay back, they will resume medical treatment after 6 months of continuous payment of medical insurance premiums. Medical expenses incurred during the interruption period cannot be applied for sporadic reimbursement.

Reason two

While waiting for medical insurance benefits.

Medical insurance benefits cannot be settled in real time during the waiting period, and medical expenses incurred during the waiting period cannot be reimbursed.

It should be pointed out that:

Flexible employees and unemployed people who participate in the basic medical insurance for employees for the first time will begin to enjoy medical insurance benefits after paying medical insurance premiums continuously for 6 months (that is, enjoying the waiting period);

The employees of the unit participate in the basic medical insurance for the first time, and enjoy the medical insurance benefits from the month after the payment is received.

Meet the conditions of insurance, after the end of the annual insurance payment period for urban and rural residents, if there are omissions or transfer of household (school) registration, go through the insurance payment procedures for urban and rural residents, and enjoy the medical insurance benefits for urban and rural residents from the month when the insurance is completed.

Reason three

The information in the social security card is not updated in time.

After the transfer of medical insurance relationship, the social security card was not replaced in time, which led to the failure to update the information in the card in time and affected its normal credit card settlement function. The insured should go through the relevant formalities at the social security card center first.

It should be pointed out that:

If the medical insurance relationship is transferred from outside the city to the employees of the employing units in our city, the unemployed registered in this city and the flexible employed registered in this city, and the payment is interrupted for less than three months during the transfer of the medical insurance relationship, the medical expenses incurred during the payment period can be applied for sporadic reimbursement within three months by transferring out the insurance certificate according to the payment standard at the time of payment. Unemployed persons registered in this Municipality and flexible employees registered in this Municipality have been interrupted for more than three months during the transfer and continuation period, and their medical insurance benefits will be restored after six months of continuous monthly payment of medical insurance premiums. Medical expenses incurred during the interruption period cannot be applied for sporadic reimbursement.

Reason four

Failing to handle the one-time payment procedures of retirement medical insurance in time.

For the insured who have gone through the formalities of pension retirement, if the payment period of medical insurance is insufficient, they need to go through the formalities of one-time payment or deferred payment of medical insurance retirement before the 23rd day of the month when they go through the formalities of pension retirement. If it is not handled in time, it will not be able to enjoy medical insurance benefits as required.

It should be pointed out that:

After the retiree goes through the formalities of paying back the medical insurance payment under the fixed number of years, if the medical insurance benefits are interrupted due to the failure to pay back in time, he will resume enjoying the medical insurance benefits from the next month after paying back the account, and if he goes through the renewal procedures again within 3 months after the interruption, the medical expenses incurred during the interruption can be applied for sporadic reimbursement according to the regulations.

Reason five

The insured person only has hospitalization medical insurance benefits.

The insured only participated in the hospitalization medical insurance for urban workers, and the insured can't pay by credit card when seeing a doctor in a hospital outpatient clinic (except for special disease outpatient clinics), nor can he buy medicine in a pharmacy.

Reason six

The insured has not prescribed a preparation for external use.

When the insured persons of basic medical insurance for urban workers buy prescription drugs at designated pharmacies (when the balance of personal accounts of medical insurance runs out, external prescriptions are required), when urban and rural residents buy prescription drugs and over-the-counter drugs at designated pharmacies, they need to write external prescriptions at designated medical institutions first, and purchase drugs at designated pharmacies within 3 days before they can settle accounts by credit card.

Reason seven

Failing to go through the procedures of transferring medical treatment in different places or designated medical treatment in different places.

If the insured person goes to Ningbo for medical treatment, but fails to go through the procedures of transferring to another place or going to the designated place for medical treatment in another place, he can't use the social security card for real-time settlement when he is in the outpatient and inpatient treatment of networked hospitals in different places in the province.

It should be pointed out that:

To go to a place outside Ningbo to see a doctor, outpatient treatment also needs to go through the formalities of transferring to other places for medical treatment;

Workers' medical insurance and urban and rural residents' medical insurance insured outpatient special disease treatment still need to be settled at their own expense and apply for sporadic reimbursement to the medical insurance agency where the insured relationship is located;

Insured persons who go through the designated procedures for medical treatment in different places can only brush their social security cards in real time in networked hospitals in different places in the province from the second month after the formalities.

Of course, in addition to the above common reasons, there are some special circumstances. The insured should first ask the medical insurance agency for specific reasons and treat them separately.