Interpretation of the New Policy of Texas Medical Insurance Reimbursement Process and Reimbursement Ratio in 2023

Medical insurance refers to social medical insurance, which is a social insurance system established to provide basic medical needs for workers within the scope of protection. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. In this article, I ask you to introduce some knowledge about medical insurance reimbursement in Texas. It mainly includes Texas medical insurance reimbursement process, Texas medical insurance reimbursement ratio and Texas medical insurance reimbursement policy.

1. The process of medical insurance reimbursement in Texas and the materials required for reimbursement are as follows:

1. The applicant has gone through the insurance formalities and paid the medical insurance premium in full.

2, cooperative medical designated medical institutions for medical treatment;

3. The medical expenses incurred by the insured in hospitalization in medical institutions shall be paid in cash in advance, and relevant documents and materials shall be kept.

Materials to be submitted for material declaration:

Individuals will arrange medical expense documents and related materials in chronological order and submit them to the unit (or social security office) for reimbursement.

1, original receipt;

2, hospitalization expenses statement;

3, discharge diagnosis certificate;

4. Copy of observation certificate or death certificate;

5, drugs, examination and treatment costs, emergency observation need to be stamped with the "emergency chapter" of the medical insurance prescription or emergency prescription of the emergency department;

6, social security card, "urban medical insurance manual";

7, the hospital full checkout certificate and unit description.

Handler:

1. The agent submits the reimbursement documents and other materials to the Dark Grey Insurance Fund Administration for acceptance;

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

3, the social insurance fund management bureau to review the materials and approve the application, the applicant to receive the "social medical insurance medical expenses reimbursement form", be reimbursed.

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.

Second, the proportion of medical insurance reimbursement in Texas and the proportion of related policies:

1. After the emergency treatment in the hospital, the medical expenses above 1800 yuan can be reimbursed, and the reimbursement rate is 50%;

2. If it is a retiree under 70 years old,1.The expenses above 300 yuan can be reimbursed, and the reimbursement rate is 70%;

3. For retirees over 70 years old,1.80% of the expenses above 300 yuan can be reimbursed.

Note: No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20,000 yuan.

In case of hospitalization expenses, employees and retirees should pay the minimum amount 1300 yuan when using the basic medical insurance for the first time in a year.

And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.

The hospitalization reimbursement standard is related to the hospital level where the insured lives:

Note: If you live in a tertiary hospital.

1, from qifubiaozhun to 30,000 yuan, the employee pays 15%, which means 85% reimbursement;

2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;

3. 95% of the part exceeding the maximum payment limit of 40,000 yuan can be reimbursed, as long as the employee pays 5%;

4. Retirees pay 60% of the employees.