How much can I reimburse for medical treatment in other places and returning to local medical insurance?

First, the proportion of medical insurance reimbursement in different places:

1. The medical expenses of medical insurance personal account can be transferred to Zigui Medical Insurance Bureau on a regular basis, and hospitals in other provinces should be designated hospitals for local medical insurance.

2. The reimbursement rate is 88% for the threshold fee of more than 3,000 yuan, 90% for 3,000-5,000 yuan, 92% for 5,000-10000 yuan, and 95% for the maximum payment limit of more than10000 yuan, including 80% for Class B drugs and 70% for precious drugs, and special inspection.

Second, the reimbursement process for medical treatment in different places:

1, before hospitalization or within 3 days after hospitalization, call the consultation number of the new rural cooperative medical system in my hometown to register the hospitalization situation;

2. After discharge, the residence certificate must be issued by the neighborhood office or neighborhood committee. If you work outside, you need a work certificate issued by your work unit;

3, after discharge with a copy of medical records, summary list, hospitalization documents, discharge certificate, and then with the patient ID card, cooperative medical certificate and proof of residence or work back to the insured place for reimbursement;

4. If you go directly to the hospital outside the province for chemotherapy from the participating place, you must go through the referral and transfer procedures before you can go to the hospital for treatment in other places;

5. The reimbursement rate outside the province is the lowest, the deductible is around 2,000, and the reimbursement rate is 45% of the reasonable expenses. The lower the hospital level, the higher the reimbursement ratio.

Extended data:

Settlement procedure

(1) Settlement procedures for inpatient and outpatient treatment of special diseases

Designated medical institutions shall submit the expense list, hospitalization list and related materials of discharged patients last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination. The medical insurance agency pre-allocated the hospitalization and outpatient expenses for special diseases last month.

Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.

(2) Emergency settlement procedures

The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall handle the reimbursement procedures according to the provisions with the emergency hospitalization medical records, inspection, laboratory test sheets, invoices and detailed list of medical expenses.

(three) resettlement procedures for resettlement personnel in different places

1. The personnel resettled in different places shall be designated as the designated medical institution of 1-2 by the unit to which they belong, and shall be reported to the medical insurance agency for the record.

2. The medical expenses incurred by the off-site staff in the outpatient department of the designated medical institution in their place of residence shall be paid in advance by themselves or their units. After the treatment, the unit should hold the diagnosis, medical records and effective expenses of the insured.

Use bills, compound prescriptions, hospitalization expenses list, etc. Settle with the social medical insurance agency on the specified date.

(4) Referral and settlement.

1. If the insured person is transferred to other medical institutions for diagnosis and treatment due to the conditions of designated medical institutions or specialized diseases, the approval form for referral and transfer shall be filled in. The reason for referral and transfer is put forward by the attending physician, the director of the department puts forward the opinion of referral and transfer, the medical institution medical insurance office reviews it, the dean in charge signs it, and it can be transferred only after being reported to the municipal medical insurance center for examination and approval.

2. In principle, referrals should be made outside the city, inside the province and outside the province. The city's referral regulations are carried out between designated medical institutions. The referral outside the city is proposed by the designated medical institutions above Grade III in this Municipality.

3. The medical expenses incurred after the insured person is referred to another hospital shall be paid by the individual or unit in cash. After the medical treatment, the insured person or his agent will submit the referral approval form, medical record certificate, prescription and valid documents to the medical insurance agency for reimbursement of hospitalization expenses that fall within the scope of the overall fund payment.

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