How to reimburse social security medical insurance

Medicare, generally referred to as basic health insurance, is a social insurance system established to compensate workers for financial losses caused by the risk of illness. Want to know more about how to reimburse social security medical insurance, follow me together.

A. Social security health insurance how to reimburse?

1, the hospital different health insurance reimbursement rate is different: If a person in the hospital with 10,000 yuan, if it is a hospital in the first hospital inpatient, then subtract 500 yuan; if it is a hospital in the second hospital inpatient, then subtract 1,000 yuan; if it is a hospital inpatient, then subtract 2,000 yuan; after that then remove the After that, "non-medical expenses" and "other non-medical expenses" will be excluded, leaving 80% for active employees and 50% for retired, unemployed and jobless people. (Note: the health insurance reimbursement only protects Class A drugs that are medication, Class B is not reimbursable for non-medicare use)

2, the working staff hospitalization medical reimbursement reimbursement ratio health insurance hospitalization, the total cost in addition to the out-of-pocket part of the Class B costs first 10% out-of-pocket after the part of more than the hospital health care insurance threshold fee, to enjoy the coordinated payment of the proportion of the hospital level of the different threshold fee is different, to enjoy the coordination of the proportion of the payment of the different.

3, the social security card does not adjust any medical reimbursement ratio, according to the 2005 introduction of the "Beijing Municipal Basic Medical Insurance Regulations", the social supplemental medical insurance for retirees under the age of 70 is 50%, and in the contributing agency for reimbursement procedures, it is necessary to prepare a copy of the medical insurance handbook, medical bills, receipts, details and other things.

Two, what is the scope of social security medical insurance reimbursement?

1, the individual account to pay for the following medical expenses:

outpatient, emergency medical expenses; to the designated retail pharmacy costs; basic medical insurance co-ordination fund below the starting standard of medical expenses; more than the starting standard of basic medical insurance co-ordination fund, according to the proportion of the medical expenses should be borne by the individual. The individual account is not enough to pay part of the self-payment.

2, the basic medical insurance fund to pay for the following medical expenses:

hospitalization medical expenses; emergency rescue and hospitalization and income in the hospital, its hospitalization within 7 days before the hospitalization of medical expenses; malignant tumors, radiation therapy and chemotherapy, renal dialysis, kidney transplantation, outpatient medical costs of anti-rejection drugs.

3, the basic medical insurance fund does not pay the following medical expenses:

In the non-designated medical institutions, but except for emergency; in the non-designated retail pharmacies to buy drugs; due to traffic accidents, medical accidents or other accidents caused by injury; due to their own drug use, fighting and assault or due to other violations of the law caused by injuries; suicide, self-inflicted injuries, alcoholism and other causes of treatment; in foreign countries or Hong Kong, Macau SAR special administrative regions. Foreign or Hong Kong, Macao Special Administrative Region and Taiwan for treatment; in accordance with national and municipal regulations should be paid by the individual.

4, the basic medical insurance system payment standards:

The basic medical insurance fund to pay the starting standard is determined by the previous year's average wage of workers in the city of about 10%. Individuals hospitalized for the second and subsequent medical expenses in a year, the basic medical insurance fund to pay the starting standard is determined by the previous year's average salary of municipal employees about 5%. The accumulated maximum payment limit of the basic medical insurance co-ordination fund for the medical expenses of the employees and retirees in a year is determined by about 4 times of the average salary of the employees in the city in the previous year.

In a settlement period (the settlement period is set according to the time of hospitalization of employees and retirees, radiotherapy and chemotherapy for malignant tumors, kidney dialysis, and outpatient treatment with anti-rejection drugs after kidney transplantation), the medical expenses incurred by employees and retirees within one year will be paid by the basic medical insurance coordinating fund at about 4 times the average salary of employees in the city in the previous year. Within the medical expenses incurred by employees and retirees, according to the level of hospital and the amount of costs to take the approach of segmented calculation, cumulative payment, by the basic medical insurance fund and the individual proportionate share.

5. Special treatment for special cases:

In order to reduce the burden of kidney dialysis, kidney transplantation, malignant tumors and psychiatric patients, and to ensure their basic medical care, certain medicines will be paid by the basic medical insurance co-ordination fund. Such as kidney dialysis patients in the outpatient clinic due to the need for medical conditions, the examination, treatment and use of related drugs; kidney transplantation anti-rejection treatment patients, in the outpatient clinic due to the need for medical conditions, the examination, treatment and use of related drugs; malignant tumors in the outpatient clinic during radiation therapy, chemotherapy, due to the need for medical conditions, use of adjuvant treatment of traditional Chinese medicine costs are also included in the basic medical insurance fund to pay the scope. The first time I saw this, it was a very good idea to get a copy of the book.

In addition, psychiatric patients will get more favorable conditions, psychiatric patients in psychiatric hospitals and psychiatric wards of general hospitals hospitalized in the psychiatric designated specialist hospitals, within a year, only once to charge the starting standard cost of the integrated fund, and reduced by 50% of the starting standard.