Proportion of medical insurance paid in different places

The reimbursement of medical insurance in different places is proportional, not all of them can be reimbursed, and some of them are borne by themselves.

1. What is the reimbursement rate for medical insurance in different places?

The reimbursement rate is 88% for the threshold fee above 3,000 yuan, 90% for 3,000-5,000 yuan, 92% for 5,000-10000 yuan, and 95% for the maximum payment limit above10000 yuan, including 80% for class B drugs, 70% for expensive drugs, special inspection and special treatment. Medical expenses of individual medical insurance accounts can be transferred to Zigui Medical Insurance Bureau regularly, and hospitals in other provinces should be designated hospitals for local medical insurance.

Second, what is the direct settlement process for medical treatment in different places?

Direct settlement of medical treatment in different places is divided into four steps:

1, apply for filing

When seeking medical treatment across provinces, the insured person needs to go to the medical insurance agency of the insured place for the record.

2. Choose regions and hospitals.

When patients seek medical treatment in different places, they should pay attention to whether the hospitals they see support the settlement of medical treatment in different places, and the level of the hospitals determines the reimbursement ratio.

3. You need a card to see a doctor.

This is very important, you must brush your social security card!

4. Discharge settlement

As I said before, in the past, medical settlement in different places had to run at both ends. Now you just need to pay what you have to pay directly when you leave the hospital.

3. Can everyone go to a different place for medical treatment and settle accounts directly?

At present, for the following groups of people, medical treatment in different places can be filed online, and the social security card can be directly used for settlement after filing ~

1. Relocation of retirees

That is, people who have settled in different places after retirement and moved their accounts.

2. Long-term residents in different places

Persons who live in different places and meet the conditions of the insured place.

3. Resident in different places

The employer stationed in different places meets the requirements of the insured place.

4, remote referral personnel (online)

Persons who meet the referral conditions of the insured place.

These four groups of people, after filing through the WeChat medical treatment plan in different places, can directly brush the social security card to settle in the hospital, which is very convenient.

Note: Online processing has geographical restrictions. Not all cities have opened off-site medical treatment settlement systems. Some areas need to go offline to local social security agencies for the record. Restricted by local policies, you can call the national unified social security hotline 12333.

Legal objectivity:

Article 28 of the Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.