Can I get reimbursed for my company's social security if I get sick? How much can be reimbursed?

Social security reimbursement scope: such as the three hospitals, for example, major diseases 150,000 cap, general hospitalization between 2,000 yuan to 75,888 yuan can be reimbursed 80%

Medicare out-of-pocket range: general 12,000 yuan of hospitalization costs, a conservative estimate of out-of-pocket expenses in the 2,000 yuan of drugs

So that 12,520 yuan of medical expenses, 6,400 yuan is the reimbursement of social security! The remaining 6,120 yuan was paid by herself.

So how was the 6,400 yuan reimbursed? 12,000 yuan - 2,000 yuan (the starting line of the tertiary hospital) = 10,000 yuan - 2,000 yuan (out-of-pocket expenses) = 8,000 yuan. 8,000 yuan * 80% = 6,400 yuan

Fortunately, after she purchased a commercial insurance policy for her hospitalization, and then got the insurance company to reimburse her for the remaining 6,000 yuan, the hospitalization was reimbursed. 12,000 yuan, the part of their own payment is out-of-pocket drug 2000 yuan. Social security + commercial insurance total **** reimbursement back to 10000 yuan. If you have social security, after the social security reimbursement, then take the split policy to the insurance company to reimburse the remaining premiums, social security has a starting line (2,000 for the three hospitals, 1,000 for the two hospitals, 500 for the one hospital).

If you don't have social security, you can buy commercial insurance directly, such as the above case of 12,000 a hospitalization cost, the reimbursement rate is, (total cost of 12,000 - out-of-pocket expenses 2000) * 80% = 8000.

Knowing the connotation of social security reimbursement rate, we will next understand the social security reimbursement needs to be aware of the process of reimbursement.

Social security reimbursement of participants in the hospitalization process

1, hospitalization conditions

(1) participate in medical insurance and hold the Shenzhen Labor Security Card or Shenzhen Employee Social Insurance Card;

(2) the previous month has been insured payment records.

2. Hospitalization Procedures

(1) If a participant consults a designated hospital and is diagnosed by the attending doctor as meeting the conditions for hospitalization, an admission notice will be issued;

(2) With the admission notice and the Shenzhen Labor Security Card or Shenzhen Employee's Social Insurance Card, the participant will go to the hospital's inpatient charging office to go through the hospitalization procedures;

(3) When being discharged from the hospital, he/she will be discharged from the hospital by presenting the Shenzhen Labor Security Card" or "Shenzhen Employee Social Insurance Card" for discharge procedures, and check the hospital charges by myself or my relatives.

3, social security card hospitalization reimbursement time limit and the required information:

Participants should submit the following information for reimbursement within 12 months from the date of incurring medical expenses (inpatient hospitalization from the date of discharge): (1) outpatient medical records (check the originals, receive a copy); (2) hospitalization records stamped with the official seal of the hospital (including the admission record, the doctor's order form, surgical records, discharge records, relevant examination and report forms) (receive a copy). (including admission records, medical orders, operation records, hospitalization records, relevant examination reports) (receive copies); (3) valid invoices (receive originals); (4) detailed list of expenses (receive copies); (5) diagnostic certificates of illnesses (receive originals); (6) certificates of the organization (for employees) (receive originals); (7) my social security card (receive originals, receive copies); (8) my bank passbook in the city (limited to the four major state-owned banks) (receive originals, receive copies).

Note: All of the above reimbursements are subject to the premise that the treatment must be received in a public hospital and that the medicines and items belong to the scope of the basic medical catalog. Therefore, when you are hospitalized, you need to inform your doctor that you have medical insurance and try to use medicines that are covered by medical insurance.

All the information will be collected and submitted within 10 working days of discharge from the hospital, and the claim will be processed within one month of the submission of the qualified information.

Precautions for social security card hospitalization reimbursement

After understanding the process of medical insurance card hospitalization reimbursement and the required information, let's take a look at the social security card hospitalization reimbursement what are the precautions:

1. Different hospitals different health insurance reimbursement ratio

If a person uses 10000 yuan in the hospital, if it is a first-class hospital hospitalization, then first subtract 500 yuan; then first subtract 500 yuan; then subtract 500 yuan; then subtract 500 yuan; then subtract 500 yuan; then subtract 500 yuan; then subtract 500 yuan. If a person is hospitalized in a level 1 hospital, 500 yuan will be deducted first; if he is hospitalized in a level 2 hospital, 1,000 yuan will be deducted first; if he is hospitalized in a level 3 hospital, 2,000 yuan will be deducted first; after that, the costs of "non-medicare medicines" and "other non-medicare expenses" will be excluded, leaving 80% for the working people and 80% for the working people. The remaining 80% is for active employees and 50% for retired, unemployed and unemployable.

Note: Health insurance reimbursement is only insured for Class A drugs, that is, medication, Class B is not reimbursable for non-medical use.

2. Hospitalization reimbursement rate for active employees

Medicare hospitalization, the total cost of hospitalization, in addition to the out-of-pocket portion of the first 10% of Category B costs out of pocket, more than the threshold fee of the hospital's health care insurance part of the payment rate, to enjoy the co-ordination of the proportion of the payment. The hospital's threshold fee is different for different levels of hospitals, and so is the percentage of the total payment. The proportion of employee health insurance is 80% or so (82%/84%/87% in Wuhan), and the proportion of resident health insurance is about 70% (80%/65%/50% in Wuhan).

Medicare hospitalization out of pocket proportion, it is not easy to say, out-of-pocket part of all of their own money, threshold fee all of their own money, the cost of Category B first out of pocket 10%, and then with the cost of Category A together, out of pocket 20% or so.