How to stipulate the second reimbursement of medical insurance in Shanxi Province

Shanxi Province, the second medical insurance reimbursement provisions are as follows:

1, outpatient service, knife injury, work injury, fire or traffic accident, hospitalization and accident, etc. The reimbursement ratio is different.

2. The reimbursement rate of each hospital is different, but generally speaking, after deducting the deductible, the part that the individual pays more than 1 10,000 yuan can be reimbursed at the rate of 60%.

3. There is no deductible for critical illness insurance, which ensures that individuals can continue to enjoy reimbursement after their self-paid compliance medical expenses reach 18000 yuan in the social security catalogue.

4. Specific groups can enjoy a higher proportion of medical insurance reimbursement, such as newborns, children, disabled people, low-income households, and poor people who have established a file.

Medical insurance reimbursement materials:

1, medical insurance card: hold a valid medical insurance card;

2. Medical records: medical records are needed, including the department, date, diagnosis result and treatment plan.

3. Prescription note: the original and photocopy of the prescription note are required, including the name, dosage, usage and time of use of the drug;

4. Receipt: the original and photocopy of the receipt for drug purchase or treatment expenses shall be provided, including the name, quantity, unit price and amount of the drug;

5. Hospitalization records: In case of hospitalization, hospitalization records, discharge summary and other hospitalization records shall be provided;

6. Other relevant materials: such as outpatient medical bills, inpatient medical bills, inspection reports issued by hospitals, laboratory tests, etc.

To sum up, the medical insurance reimbursement process may be slightly different in different regions, and the specific operation steps can be adjusted according to local policies and actual conditions.

Legal basis:

Article 2 of People's Republic of China (PRC) Social Insurance Law

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 get material help from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.

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The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.

Article 4

Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.

Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.