Hangzhou social health insurance how to reimbursement and process

Nowadays more and more people buy social security, and in Hangzhou to buy social security and how to reimburse it? The following is to understand the vision editorial compiled some relevant information about Hangzhou social security reimbursement, for your reference.

Hangzhou social security reimbursement method declaration materials

A, the necessary materials:

Participant's own social security card, the participant himself or her agent has the UnionPay logo Xiamen local savings card, the agent of the original ID card and photocopies

Two, the medical materials:

(a) outpatient medical expenses reimbursement:

Original outpatient invoice, detailed list of medical expenses, outpatient (emergency) medical records (detailed and complete diagnosis and treatment records).

(2) Reimbursement of inpatient medical expenses:

Original hospitalization invoice, summary list of medical expenses, and discharge summary or record (stage summary is provided for midway settlement of accounts, and death record for those who died).

Three, the reimbursement category and proof of class materials:

1, the transfer of foreign medical treatment: must be transferred to foreign medical reporting procedures, such as emergency, should be transferred to the hospital within seven days of admission to make up for the formalities;

2, the relocation of foreign settlements, foreign work: the requirements of foreign residence, work in more than six months, and must be reported to the procedures beforehand;

3, business trips, family visits, tourism and other short-term out During the medical expenses: ① acute illness: reimbursement to provide proof of business trip, proof of family visits, travel contracts, real-name air tickets, etc.); ② outpatient maintenance of chronic diseases: increase the provision of Xiamen diagnosis and treatment of medical records, diagnostic and therapeutic measures during the period of time out of the Xiamen can not exceed the original diagnostic and therapeutic measures in the Xiamen;

4, childbirth in a different place: hospitalization and delivery of a reasonable prenatal, postnatal check-up costs;

5, Xiamen local and homogenized areas of social security system failure can not be real-time card settlement: invoice endorsement by the medical institution fee office to prove and stamp;

6, social security card loss or damage, delay in card production: social security card management section of the back of the invoice stamped to confirm;

7, outpatient clinics in a single month, the number of visits exceeded 20 times: the charge note must be card settlement and show the number of registered, must provide clinic records

8, acute illness or rescue did not carry a social security card: outpatient or hospitalization records should be recorded in detail, clear enough to be recognized as an acute illness or rescue;

9, the cost of drugs outside the directory of retired cadres: need to provide? Retired cadres out-of-catalog drug approval form? and stamped with the official seal of the hospital's health insurance management department; the health care object of the retired cadres hosted by the provincial two-fee center must provide health care certificates;

10, insurance status, change (interruption of payment of not more than one month), change the unit of participation in the local tax data to delay the arrival of the account: the local tax for the completion of the procedures for change and the confirmation of arrival in mid-month the following month can be processed for reimbursement;

11, newborns born with medical expenses: Within three months of birth should be timely for enrollment and payment, in the payment to the account before reimbursement. Must provide a birth certificate (original, photocopy); incurred expenses when the newborn is not named, medical invoices, summary lists, discharge records and other reimbursement vouchers on the name of the uniform use of the mother's or father's name followed by the addition of ? Zi Zi? or? daughter?

12, traffic accidents or other accidents and injuries (except the participant is not responsible): traffic accidents must provide the traffic police issued a certificate of responsibility for the accident, the third party has been paid medical expenses will not be repeated, is a participant of drunk driving, driving without a license, or other self-intentional behavior caused by the person will not be reimbursed; other accidents and injuries to provide the public security department's certificate of responsibility for the accident, the person is intentional, Participate in a fight or violation of public security regulations can not be reimbursed;

13, the first to pay: unable to determine the third party (public security or judicial department certificate), or although the third party can be identified but the court implementation difficulties (court certificate), fill out the "Xiamen Basic Medical Insurance Fund first to pay the application", submitted to the examination and verification of compliance with the social security law provides for the scope of the first to pay for reimbursement before processing;

14, while participating in commercial insurance or other non-social basic medical insurance: commercial insurance and other insurance has been paid, you need to provide the original invoice stamped with the special seal of the claim business, the claim decision and the calculation of the cost of the claim list, the commercial insurance and other insurance has been paid for the medical expenses of the health insurance fund will not be repeated reimbursement.

Hangzhou social health insurance reimbursement method 1, the hospital different health insurance reimbursement ratio is different: if a person in the hospital with 10,000 yuan, if it is in the first level of hospital inpatient hospitals, then the first minus 500 yuan; if it is in the second level of hospital inpatient hospitals, the first minus 1,000 yuan; if it is the third level of hospital inpatient hospitals, then the first minus 2,000 yuan; after that then remove the The cost of non-Medicare medicines? the cost of non-medicare medication? and other non-Medicare-covered expenses. other non-medicare expenses. , leaving 80% for active employees and 50% for retired or unemployed or jobless. (Note: the health insurance reimbursement only insurance class A drugs that the medical insurance drugs, class B for non-medical insurance can not be reimbursed)

2, the working staff hospitalization medical reimbursement reimbursement ratio health insurance hospitalization, the total cost in addition to the out-of-pocket part, class B costs first out-of-pocket 10% after the part of more than the hospital medical insurance threshold fee, enjoy the proportion of the co-ordination of the payment of the hospital level of the different threshold fee, enjoy the co-ordination of the proportion of the payment of the different. Employee health insurance ratio of eighty percent (Wuhan 82%/84%/87%), the proportion of residents health insurance about 70% (Wuhan 80%/65%/50%).

3, the social security card does not adjust any medical reimbursement rate, according to the "Beijing Municipal Basic Medical Insurance Regulations" issued in 2005, the social supplemental medical insurance for retirees under the age of 70 is 50%, and in the contributing agency for the reimbursement procedures, it is necessary to prepare a copy of the medical insurance manual, bills, receipts, details and so on, the details of which can also be

The main function of social security is to stabilize social life

2. redistribute

3. promote socio-economic development: the first is that the social insurance system functions as an important tool for demand management, thus playing a positive role in the economy. The second is that the effective utilization of the social insurance fund can promote sustained economic prosperity.

Hangzhou social security reimbursement of