Provisions of Wuxi Municipality on the Proportion of Medical Insurance Reimbursement

For the first visit in the community health service center, the threshold for hospitalization expenses is 200 yuan, in which 90% of eligible medical expenses are paid by the fund, 10% by individuals and 65% by tertiary medical institutions. 300 yuan, a student, and 600 yuan, another resident. For hospitalization in secondary medical institutions, the eligible medical expenses fund will bear 75%, the individual will bear 25% and the individual will bear 65%. Out of the city, the fund pays 55%, and the individual pays 45%. If the transfer procedures are not handled according to the regulations, the fund will pay 50% of the above standards.

The first is the conditions for reimbursement of medical insurance in different places.

1. The medical expenses incurred by the insured who have gone through the registration procedures for medical treatment in different places, such as resettlement, visiting relatives, working and studying abroad, are paid in cash at the designated medical institutions of medical insurance in different places.

2, the provincial insured agreed to transfer to Beijing, Shanghai medical insurance designated medical institutions for medical expenses in cash.

Second, the reimbursement rate of medical insurance in different places (up to 90%)

1, outpatient reimbursement ratio

There is no deductible line for general outpatient service, and all insured residents enjoy the treatment of general outpatient service.

Within a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund payment are reimbursed according to the proportion of 60%, and the annual maximum personal payment limit of co-ordination fund is 400 yuan.

2. Proportion of hospitalization reimbursement

The longer the continuous insurance period, the greater the reimbursement ratio. The proportion of hospitalization reimbursement of medical insurance fund will be increased by 5 percentage points every 5 years after the insured residents pay continuously, and the cumulative reimbursement ratio will not exceed 10 percentage point.

If you continue to participate in insurance 10 years from 2007, the reimbursement rates of hospitalization in tertiary, secondary and primary hospitals will reach 70%, 80% and 90% respectively.

3. Secondary reimbursement ratio

After the "second reimbursement", the medical expenses incurred by the insured residents in a single hospitalization belong to the part paid by the urban residents' basic medical insurance pooling fund, and there may be a "second reimbursement". After the basic medical insurance fund is paid in proportion, the personal burden exceeds 8,000 yuan, and the serious illness insurance fund gives "second reimbursement" to more than 55%.

Third, the process of medical insurance reimbursement in different places.

1, to receive or download the Application Form for Working and Living in Different Places of the Municipal Basic Medical Insurance (hereinafter referred to as the Application Form) on the social security website;

2, according to the provisions of the fill in, and by the foreign social insurance (medical insurance) agencies stamped "declaration form";

3 will fill out the "declaration form" back to the social insurance agency responsible for the division of labor for review and confirmation.

Need to apply for a medical card in different places in the province, with the "declaration form" after examination and confirmation to the municipal social security center audit department for registration, and then to the social security card management department for the card making procedures in different places in the province;

4. The insured person's personal social security card cannot be used after filing; If the insured person returns for medical treatment, he should go to the municipal social security agency for cancellation of medical registration, and his personal social security card can be used in designated medical institutions from the next day;

5. Implement the principle of reporting changes but not reporting.

Fourth, the materials needed for medical insurance reimbursement in different places.

1, copy of application form for medical treatment in different places

2. The formal invoice of pharmacy (supervised by State Taxation Administration of The People's Republic of China Finance Department, with the details of purchased drugs listed on the invoice) or the outpatient receipt of designated hospital.

3. Patient ID card and agent ID card

4. My passbook bank card account number (except for rural credit cooperatives) (bank name is required in external account)

Legal basis:

People's Republic of China (PRC) social insurance law

Article 1 This Law is formulated in accordance with the Constitution for the purpose of adjusting the social insurance relationship, safeguarding citizens' legitimate rights and interests in participating in social insurance and enjoying social insurance benefits, enabling citizens to enjoy the fruits of development and promoting social harmony and stability.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Article 3 The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.

Article 4 Employers and individuals who pay social insurance premiums according to law in People's Republic of China (PRC) have the right to inquire about payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services.

Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.