What materials and processes are needed for social security reimbursement?

Original ID card of materials and procedures required for social security reimbursement; Original medical diagnosis certificate; Original medical data such as outpatient medical records, examination and test results reports; Original receipt of general outpatient emergency charges, detailed list of outpatient expenses or original prescription. Submission time: every month 1- 10, the current month's fee will be submitted the next month, and the current year's fee will be submitted before 1 the following year. Handling process: If the accumulated threshold is exceeded in a natural year, the unit manager will input all the documents into the enterprise software and report the generated electronic information and statements to the medical insurance center, which will complete the review, settlement and payment of reimbursement expenses within 30 working days. Maternity reimbursement 1. Materials required for maternity allowance: 1, original and photocopy of marriage certificate; One original and one copy of the Maternity Service Certificate; One original and one copy of the baby's birth certificate; One original and one copy of the medical diagnosis certificate; "Registration Form for Persons Applying for Maternity Allowance" in duplicate. Note: The above copies must be on A4 paper. 2. Submission time: 1- 10 days per month. 3. Handling process: the unit manager will submit the above materials to the social security center, and pay the maternity allowance within 30 working days after accepting the approval. Those who meet the conditions of enjoying the bonus and allowance for childbearing, who choose the object of enjoying the allowance for childbearing in the Information Registration Form of Persons Applying for Maternity Allowance in Beijing, shall be signed and confirmed by both husband and wife, and sealed by both units. If both husband and wife have participated in maternity insurance, the woman's unit shall fill in the Information Registration Form for Persons Applying for Maternity Allowance in Beijing; If the woman has not participated in maternity insurance, and the man has participated in maternity insurance, and the man enjoys the maternity allowance, the unit where the man works shall fill in the Information Registration Form for Persons Applying for Maternity Allowance in Beijing and make a declaration. 2. Materials required for maternity medical expenses: 1. One original and one copy of the Maternity Service Certificate; A copy of the baby's birth certificate; Copy of medical diagnosis certificate; All original receipts and prescriptions are arranged smoothly according to the date; A Declaration Form for Manual Reimbursement of Maternity Insurance Medical Expenses. 2. Submission time: 1- 10 days per month. 3. Handling process: the manager of the insured unit submits the above materials to the social security center and pays the maternity medical expenses within 30 working days after accepting the approval. Three. Materials required for medical expenses of family planning operation: 1, and the original and photocopy of the Maternity Service Certificate 1 copy; A copy of the baby's birth certificate; Copy of medical diagnosis certificate; The originals of all receipts, prescriptions, details of hospitalization expenses and hospitalization settlement list shall be arranged in chronological order; A Declaration Form for Manual Reimbursement of Maternity Insurance Medical Expenses. 2. Submission time: 1- 10 days per month. 3. Handling process: the unit manager submits the above materials to the social security center on June 5438+0-20 every month, and pays the medical expenses for family planning surgery within 30 working days after accepting the approval. Materials required for work-related injury reimbursement: 1. The application form for work-related injury identification is in quadruplicate, and the copy is invalid; One original and one copy of the diagnosis certificate and the diagnosis certificate of outpatient cases or occupational diseases; One original and one copy of the text of the labor contract; Copy of the injured person's ID card; 2. Submission time: 1- 10 every month. 3. Handling process: application: the unit manager submits the above materials to the social security center; Acceptance: the work-related injury identification department will review the application within 15 days after receiving it. Those who meet the conditions should be admitted. If the application materials are incomplete, inform the unit manager to fill in the materials within 30 days; Identification: within 60 days after the review, make a notice of the conclusion of work-related injury identification and inform the unit manager, inform the unit manager if it does not meet the identification conditions, and issue a work-related injury identification letter if it is identified as a work-related injury; Appraisal: If the work stoppage expires or the injury is basically stable after treatment, the applicant shall submit the labor ability appraisal to the labor ability appraisal committee to assess the disability level; Work-related injury insurance benefits: If it is qualified to enjoy work-related injury insurance benefits after appraisal, the unit manager will apply to the social security center for review of benefits, and the social security center will pay the benefits to the workers with work-related injuries within the specified time according to the approved benefits. Conditions and procedures for social security reimbursement 1. Scope of reimbursement for outpatient expenses: general outpatient and emergency expenses incurred by the insured in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by individuals. Reimbursement ratio: if the emergency expenses of general outpatient service exceed 2,000 yuan in a natural year, 50% will be paid by some large medical mutual aid funds above 2,000 yuan, and 50% will be paid by individuals themselves. The retirees have accumulated more than 1.300 yuan, and the part that exceeds 1.300 yuan is covered by the large medical mutual aid fund over 70 years old, with 70% paid by individuals, 30% paid by individuals, 80% paid by the large medical mutual aid fund over 70 years old and 20% paid by individuals. The maximum payment limit in a natural year is 20000 yuan. Medical management: individual cash payment for general outpatient and emergency expenses, and the medical expenses incurred shall conform to the three categories of medical insurance. When purchasing drugs, special prescriptions should be issued in designated hospitals and stamped with the special seal for medical insurance outsourcing, and then drugs should be purchased in designated pharmacies. Reimbursement process: If the accumulated amount exceeds the minimum payment standard in a natural year, the insured shall submit the documents to the unit or social security office, which will enter the documents into the enterprise version and declare the electronic information and documents to the medical insurance center. The medical insurance center will complete the examination, settlement and payment within 15 working days. Application materials: general outpatient and emergency receipts, medical insurance prescriptions, and details of examination and treatment expenses. Declaration date: every month 1-20, the expenses of the current month will be declared next month, and the expenses of the current year will be declared again before 65438+ 10/20 of the following year. Two. Reimbursement scope of hospitalization expenses: hospitalization expenses incurred by the insured in designated hospitals or specialized hospitals, traditional Chinese medicine hospitals and 3A hospitals selected by individuals. Reimbursement ratio: minimum payment for the first hospitalization in a natural year 1.300 yuan, each time in 650 yuan. The payment ratio is divided into three grades. Take a tertiary hospital as an example. The floating standards are: 30,000 yuan, 85% on the job, 9 1% for retirement, 90% for 30,000-40,000, 94% for retirement, more than 40,000, 95% for employment and 97% for retirement. 90 days of general hospitalization is a settlement cycle. Psychiatric hospitalization for 360 days is a settlement cycle, and the floating standard is halved. In a natural year, the overall fund pays a maximum of 70,000 yuan. The maximum hospitalization amount is 654.38+10,000 yuan, and the hospitalization ratio is 70%. Medical management: Please use Beijing Medical Insurance Manual for medical treatment. If the unit pays in full, the individual only needs to pay part of the hospitalization prepayment to go through the hospitalization procedures. The medical expenses incurred should conform to the scope of the three major catalogues of medical insurance. Reimbursement process: At the time of discharge, the hospital and the individual will settle their own expenses and their own expenses, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center. Third, the scope of reimbursement for outpatient special diseases: the outpatient medical expenses incurred by the insured after handling the examination and approval procedures for special diseases due to radiotherapy and chemotherapy for malignant tumors, renal dialysis and taking anti-rejection drugs after renal transplantation. Reimbursement ratio: reimbursement ratio is the same as hospitalization. The settlement period of outpatient special diseases is 360 days. Medical management: the insured can only choose one hospital as the designated hospital for special diseases. Please use the Beijing Medical Insurance Manual for medical treatment. If the unit pays the full amount, the individual only needs to pay the personal out-of-pocket expenses and the self-funded part, and the reimbursement amount of the overall fund is settled by the hospital and the district medical insurance center. Reimbursement process: the insured submits the documents to the unit or social security office, and the unit declares the documents to the medical insurance center. The medical insurance center completed the audit, settlement and payment on the same day. I'm here to sort out the information about these problems, hoping to help you. The laws in China are gradually improving, and we look forward to helping more people.