Zhuhai Medical Insurance Reimbursement Policy

1, urban and rural residents, students and minors participate in the second basic medical insurance in Zhuhai, and the financial subsidy standard is 590 yuan per person per year (including outpatient co-ordination in 25 yuan), which is shared by the municipal and district finances in a ratio of 5 to 5;

2, urban and rural residents to participate in the second basic medical insurance in Zhuhai, the individual payment standard is 4 10 yuan per person per year (including outpatient co-ordination in 25 yuan); Students and minors participate in the second grade of Zhuhai basic medical insurance, and their individual payment standard may be 180 yuan per person per year (among which the outpatient service is co-ordinated in 25 yuan). Outpatient service: 70% of the medical expenses incurred by the insured in the selected outpatient co-ordination institution shall be paid by the basic medical insurance co-ordination fund, and 30% shall be paid by the individual.

Hospitalization: the proportion of approved medical expenses reimbursement for Class I insured persons in this city.

If the Qifubiaozhun occurred in a social security year is higher than the maximum payment limit, 92% will be paid by the on-the-job personnel pooling fund and 94% by the medical insurance retirees pooling fund. Among them, 10% shall be paid for the disposable materials with a unit price of 2000 yuan or more, and 70% shall be paid by the overall fund.

The proportion of reimbursement of medical expenses approved by the second-class insured in the city.

Within a social security year, if the Qifubiaozhun is above and the maximum payment limit is within, the overall fund will pay 90%. Among them, 10% shall be paid for the disposable materials with a unit price of 2000 yuan or more, and 70% shall be paid by the overall fund.

Handler:

1. The agent submits the reimbursement documents and other materials to Zhuhai Social Insurance Fund Management Center and its office for acceptance;

2. After receiving the application materials, the accepting department will complete the examination, settlement and payment on the same day;

3 Zhuhai Social Insurance Fund Management Center and its office review the materials and approve the application. The applicant will be reimbursed after receiving the "Social Medical Insurance Medical Expense Reimbursement Form".

Note: If the application materials are incomplete and all contents need to be corrected, the applicant shall correct the materials within 5 days from the date of receiving the Notice of Corrected Materials. If no correction is made within the time limit, the application shall be deemed to have been withdrawn.

However, after the materials are corrected, the applicant may reapply within the statutory validity period. The applicant shall be reimbursed after receiving the Social Medical Insurance Medical Expense Reimbursement Form.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

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. Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations. Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government. Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.