Jiangsu Province, the latest policy of employee health insurance

1, by the urban and rural residents health insurance fund in proportion: township health centers, community health service institutions not less than 80%; county-level medical institutions not less than 70%; municipal medical institutions not less than 60%.

2, the insured residents hospitalized in provincial fixed-point medical institutions, the starting standard in accordance with the previous year's provincial fixed-point medical institutions hospitalization average cost of about 10% to determine, and not less than 1,500 yuan, hospitalization within the scope of the policy to pay the proportion of medical fees is not less than 50%.

3, urban and rural residents health insurance fund to set the maximum payment limit for hospitalization. A settlement year, urban and rural residents of basic medical insurance (excluding urban and rural residents of large-scale disease insurance) cumulative maximum payment limit of 150,000 yuan.

For the insured workers, within the policy scope of uremia dialysis, organ transplantation anti-rejection drug treatment, chemotherapy and radiotherapy for malignant tumors, the accumulated cost of drugs and treatment within 40,000 yuan (including 40,000 yuan), by the basic medical insurance fund at a rate of 90% of the settlement; more than 40,000 yuan to 100,000 yuan (including 100,000 yuan) within the settlement of the part of the basic medical insurance fund at a rate of 95% of the settlement. The proportion of the settlement.

In the settlement year, the part of hospitalization and specific outpatient medical expenses that meet the requirements of the insured workers and exceed 100,000 yuan in total will be settled by the large medical expenses social ****ji fund at a rate of 95%, and the individual will be responsible for 5% of the expenses. For urban and rural health insurance participants, the policy scope of uremia dialysis, chemotherapy and radiotherapy of malignant tumors, organ transplantation, anti-rejection drug treatment costs, within 100,000 yuan of the part of the residents of the medical insurance fund at a rate of 90% of the settlement.

General outpatient medical expenses (excluding medical expenses for specific outpatient programs) that meet the requirements of the Suzhou Health Insurance are first paid from the individual account. After the individual account is exhausted, in each settlement year (April to March of the following year), the local supplementary medical insurance co-ordination fund will settle the medical expenses at the rate of 90% of the total medical expenses within the limit of 2500 RMB (excluding the above mentioned amount of self-assumption), after the individual contribution of 600 RMB by the active employees (including the insured persons of flexible employment and the "co-insured" persons) and 400 RMB by the retired persons. The local supplementary medical insurance fund will settle the payment according to the proportion. Among them, the outpatient expenses incurred in the designated community health service stations (centers), outpatient clinics (clinics), unit health clinics and township hospitals in the urban area of class B and above using the Social Insurance Card shall be settled at the rate of 70% for active employees and 80% for retired staff; the outpatient expenses incurred in other designated medical institutions of class B and above in the urban area and designated retail pharmacies shall be settled at the rate of 60% for active employees and 70% for retired staff. The standard settlement.

2. Every time a participant is hospitalized in Suzhou, he or she is responsible for the medical expenses within the starting standard, which can be offset by the balance of the individual account in previous years.

(1) Suzhou health insurance participants in the billing year (April to March) the first hospitalization of the starting standard according to different levels of hospitals were determined, municipal and municipal hospitals: working employees (including flexible employment participants, "co-insurance" personnel, the same below) 800 yuan, retirees 700 yuan; district (county) District (county) level hospitals, specialized hospitals: 600 yuan for active employees, 500 yuan for retirees; townships and other grass-roots hospitals: 400 yuan for both active employees and retirees.

(2) The starting standard for the second hospitalization in the same year is 50% of the starting standard for the first hospitalization; the starting standard for the third or more hospitalizations is 200 RMB.

(3) If the hospitalization is more than 180 days in a row, the hospitalization will be settled once every 180 days, and the part of the hospitalization that is more than 180 days will be treated as a re-hospitalization.

(4) Where the city's Guangji Hospital, Psychiatric Rehabilitation Hospital, High-tech Zone Ankang Hospital, Taicang Ankang Hospital, hospitalized participants diagnosed with mental illness, the hospitalization costs incurred in line with the provisions of the health insurance settlement does not set a starting standard, and directly in accordance with the hospitalization of the settlement of the settlement.

(5) If the condition of the patient requires the transfer of hospitalization within the city for continuous hospitalization, he/she can go to the Municipal Social Security Center with the billing vouchers and invoices to be discharged from the hospital to be calculated according to the starting standard of the hospital of a higher grade.

How to get reimbursed by Suzhou Health Insurance

1. On-site settlement

Material: ID card/social security card of the insured person.

(1) Admission process: the participant with his social security card or ID card (children can provide a household register) for social security registration procedures - → to the ward hospitalization.

(2) Discharge process: the doctor arranges for discharge - → with their social security card or ID card (children can provide a household register) and the information required by the hospital to go to the inpatient billing office for discharge settlement procedures.

2, sporadic reimbursement

materials: the cost of the first personal advance, and within three months after discharge with the relevant information (the original list of medical expenses, receipts or invoices, original diagnostic certificates, etc.) to the social security institutions where the insurance for hospitalization reimbursement procedures.

(1) Review the information submitted by the participant

(2) After meeting the requirements, the accounting will be done according to the requirements of the documents and the standards of the three catalogs

(3) The relevant information will be entered into the health insurance system, and there will be an automatic settlement by the system

(4) Printing the list of the end of the basic medical insurance expenses

(5) The person who handles the procedure will confirm and sign for the reimbursement.

Legal basis:

"Chinese People's Republic of China *** and the State of urban workers' basic medical insurance regulations"

Article 28 of the individual account for the payment of medical expenses outside the scope of the integrated fund; the individual account is not enough to pay for, at their own expense.

Article 29 of the hospitalization of serious illnesses, medical expenses, in accordance with the following methods of payment:

(a) the starting standard in principle in the city, county, autonomous county employees in the previous year 9% -11% of the average annual social wage

(b) the maximum payment limit in principle in the city, county, autonomous county employees in the previous year 3-5 times the average annual social wage.

(c) Medical fees above the threshold and below the maximum payment limit are mainly paid by the integrated fund, with a certain percentage borne by individuals. The proportion of medical expenses borne by retirees will be appropriately taken care of.

The scope of serious illnesses, the starting standard, the specific criteria for the maximum payment limit, and the proportion of medical expenses above the starting standard and below the maximum payment limit shall be determined by the provincial people's government.

Article 30 below the starting standard, the maximum payment limit. Medical expenses, the integrated fund will not pay.

Expansion:Jiangsu Medical Card

Jiangsu Medical Card

Jiangsu Medical Card

Jiangsu Medical Card is common within the province, but did not do the procedures of the medical treatment of the other side, the direct transfer of the card personal advances of the medical costs need to be reimbursed to the place of participation. Jiangsu Province, the insured person can go to the insured place of consultation for the province's medical procedures, after the success of the social security card can be held (provincial card) to the corresponding hospitals direct card settlement of medical expenses. Not to do direct card personal advances to the medical expenses to be reimbursed to the place of participation.

At present, 13 provincial municipalities in Jiangsu Province have been interconnected with the provincial medical settlement platform, Taizhou, Suqian, Suzhou, Nantong, Yancheng and other provincial municipalities within the scope of the realization of the insured person to see the card to reimbursement of medical treatment, Wuxi, Changzhou, Yancheng, Yangzhou, Zhenjiang, Taizhou and other urban areas of the city of the city of the realization of the inter-city network settlement. Changzhou, Nantong, Lianyungang, Yangzhou, Zhenjiang, Wuxi, Dafeng, Taicang and Shanghai have realized mutual reimbursement of medical expenses on behalf of each other.

Taking Nanjing, Jiangsu Province as an example

Employees and residents insured in Nanjing need to seek medical treatment in a different place because of "relocation, long-term residence, long-term work or study, and referral to a different place for medical treatment".

In addition to the advance medical record, the need to consult the hospital has access to the outpatient settlement system for outpatient medical treatment; also need to apply for a good Jiangsu Province social security card ("provincial card") in advance.

The "provincial card" is also known as the Jiangsu Provincial Social Security Card.

As a result of cross-provincial, foreign medical card settlement can not use the Nanjing Citizen Card, you need to apply for the Jiangsu Province social security card. After the application, whether in other cities or Nanjing to see a doctor, you have to brush the provincial card. Public transportation, banking and banking functions are also retained in the Nanjing Citizen Card.

Process

1, the applicant to bring their own valid identity documents, "foreign medical registration form" to the city, district social security card service outlets to fill out the application form for the provincial card, the normal card cycle for 35 days.

When receiving the card, you must bring your valid ID to the application network to receive. If you entrust someone else to do it for you, you must also bring the original valid ID of the person you are entrusting.

2. If the unit is unified, it must provide a letter of introduction from the unit (stamped with the official seal), a list of staff (stamped with the official seal), and a copy of the front and back of the ID card of the person who handles the application.

Emergency card

If you need to use the card urgently due to illness, you can go to the Nanjing Citizen Card Service Center to apply for expedited processing. To do this, you need to bring your own "registration form for medical treatment in a different place" and the relevant hospital medical certificates, as well as the original of your valid ID card.

If you entrust someone else to do it for you, you must also bring the original valid ID of the person who is entrusted to do it for you.

The expedited card cycle is 5 working days.

Note

1, the city's normal application for medical treatment in a different place and expedited application for the provincial card, the current temporary unified system and the Bank of Communications issued by the provincial card.

2, the application of the provincial card of Nanjing citizens to receive the provincial card, the original Citizen Card on the social security functions in the future by the provincial card replacement, the original Citizen Card on the Jinling Tong and banking functions remain unchanged. If the provincial card is lost, the provincial card will be replaced and the citizen card will no longer be replaced.

Jiangsu Medical Insurance Card

Jiangsu Province, social security card processing time

Jiangsu Province, the Social Security Bureau of the hall office hours are Monday to Friday morning 9:00-12:00, afternoon 13:00-17:00, Saturday and Sunday closed. Citizens can go to the social security bureau to apply for social security cards during these hours.

The conditions for applying for the social security card in Jiangsu Province

1. Units that have completed the production of social security cards;

2. Persons with household registration in the city and persons with non-city registration who are entitled to social security and other social ****services in the city according to the law, as well as foreigners, stateless persons, and persons from Taiwan, Hong Kong, and Macao, who are employed and participate in the social insurance in the city according to the law.

Medicare Card

Jiangsu Province, social security card service outlets:

1, network services: the province's social security card service outlets and financial institutions in accordance with their respective divisions of labor, to provide social security card-related business counter services.

2, online services: individuals or units logging "Jiangsu Province, human resources and social security network" or "Jiangsu Province, social security card services network", online social security card-related business.

3, telephone service: call the human resources and social security service hotline 12333 in all parts of the province, you can consult the social security card business, for social security card temporary loss of business.

4, self-service terminals: cardholders can inquire about their human resources and social security rights and interests through self-service terminals or all-in-one machines set up by human resources and social security agencies and cooperative financial institutions at all levels of service outlets throughout the province.