How to use social security card

Instructions on the use and reimbursement of Carmen (emergency) clinic in Beijing Social Security Bureau

1, what is the function of social security card?

Insured people can enjoy the convenience of "real-time settlement" when they go to the designated medical insurance hospital with social security card and basic medical insurance manual, and only need to pay the medical expenses that the individual should bear, and the documents do not need to be submitted to the medical insurance center for re-examination and reimbursement, which solves the problems of long reimbursement period and occupation of personal funds.

2. Which hospitals can I go to with my social security card?

After the implementation of the card for medical treatment, the insured person's medical treatment is still subject to the designated medical institutions selected in the personal medical insurance manual. In addition, Class A, designated Chinese medicine hospitals, and designated specialized hospitals for medical insurance do not need to choose, and they can directly seek medical treatment with "one card and two volumes".

3. How to use social security card to see a doctor?

Insured persons need to bring "one card and two volumes", namely "social security card", "Beijing basic medical insurance manual (original)" and "Beijing medical institution emergency medical record manual" to the selected designated medical institutions for medical treatment.

Social security card should be used for registration when seeking medical treatment, and social security card and Medical Record Manual should be presented to the doctor actively when seeking medical treatment in outpatient department. When charging, social security cards should also be used for real-time settlement, and individuals should pay and pay their own expenses.

If some hospitals have their own medical cards, when the insured person takes the social security card for medical treatment for the first time, he should first go through the relevant procedures between the medical card and the social security card, and then take the social security card for medical treatment. If the two cards are related before going to the hospital, the insured only needs to hold a social security card for medical treatment, and does not need to hold a medical card. The inpatient medical card only provides services for non-insured persons.

4. Can I get reimbursement for seeing a doctor without a card?

If the insured person goes to the hospital that has opened the card real-time settlement service and fails to provide the social security card, the current medical expenses will not be reimbursed by the medical insurance fund, and all will be borne by the individual.

5. Under what special circumstances can the medical expenses paid in full by the insured be reimbursed?

In any of the following circumstances, the medical expenses are still paid in full by the insured person in cash, and the real-time settlement cannot be directly completed in the hospital. If the medical insurance payment conditions are met, the manual reimbursement procedures shall be handled according to the original process.

Failing to hold a social security card due to acute illness;

Family planning operation;

Enterprise arrears;

Manual reimbursement;

During the replacement of social security cards;

No social security card was issued after insurance.

In addition, the medical expenses related to industrial injury insurance and maternity insurance will not be settled by social security card for the time being, and the emergency observation expenses will not be settled by social security card for the time being, and their medical expenses will still be reimbursed according to the original process.

6. How can an insured person with a social security card go to a designated medical institution that does not have the conditions for swiping a card?

After the insured holds "one card and two volumes" to the designated medical institutions that do not have the conditions for swiping cards, the designated medical institutions will collect cash in full, issue medical expense documents printed with the words "upload" for the insured, and upload the details of medical expenses. The insured shall declare the medical expenses according to the original process, and submit the social security card at the same time when submitting the reimbursement.

7. How can the insured who does not have a social security card be reimbursed for medical treatment?

Insured persons still need to go to designated hospitals, third-class first-class hospitals, designated Chinese medicine hospitals and designated specialized hospitals for medical treatment according to the original regulations, show blueprints, scan bar codes, pay medical expenses in full in cash, keep charging documents, prescriptions, detailed lists and other materials, reimburse medical expenses according to the original process, and submit them in time before issuing cards.

8. Before receiving and using the social security card, how to reimburse the medical expenses that meet the medical insurance requirements?

Before the insured person receives and uses the social security card, according to the original medical insurance (holding the blueprint for medical treatment), the outpatient "upload" medical expenses that meet the medical insurance requirements should be reimbursed as soon as possible. Before the social security card is issued, it can be reimbursed according to the original process; After the social security card is issued, the social security card needs to be submitted for reimbursement according to the original process.

9. How to see a doctor during the period of social security card replacement (replacement)?

Insured persons should take the initiative to show the newly developed social security card certificate when they apply for a replacement social security card and go to designated medical institutions for medical treatment. Designated medical institutions collect relevant information according to the vouchers of new cards and reissued social security cards, and upload the details of expenses. When the designated medical institutions settle medical expenses for the insured, they will collect cash in full and issue relevant documents, and the insured will declare medical expenses according to the original process with a new social security card.

10. How to reimburse people who have been away from home for a long time when the social security card is relocated? How to reimburse the emergency medical expenses incurred by employees on business trips?

If the medical expenses incurred by retirees who have issued social security cards and on-the-job personnel who have gone abroad for medical treatment for a long time meet the payment conditions of the medical insurance fund, the medical expenses will be reimbursed according to the original process with the social security card and medical expense documents. If the emergency medical expenses incurred by the cardholder on a business trip in different places meet the payment conditions of the medical insurance fund, the social security card and medical expense documents shall be submitted and the medical expenses shall be reimbursed according to the original process.

1 1. How to reimburse the medical expenses of the social security card?

When the insured holds a social security card for medical registration, the outpatient (emergency) consultation fee will be paid in proportion after the original accumulation, adjusted to 2 yuan and paid by the medical insurance fund, and the rest will be paid by the insured in cash. (Amount of outpatient (emergency) consultation: 4 yuan, a tertiary hospital, 3 yuan, a secondary hospital, and 2.5 yuan, a first-class and below hospital).

12. How do cardholders with special outpatient diseases see a doctor?

After receiving the social security card, the insured person with special diseases in outpatient service will take the social security card to the local district and county medical insurance agency for examination and approval of special diseases in outpatient service, and then the expenses for special diseases can be settled in designated hospitals.

13. How to read the real-time settlement bill?

After the insured holds the social security card to settle the medical expenses, the designated medical institutions provide the insured with computer-printed bills. In addition to the customized content, the charging bill also prints the settlement results of the insured's medical expenses.

"The amount within the scope of medical insurance" refers to the total amount that can be included in the scope of medical insurance payment;

"This medical insurance fund payment" refers to the total expenses that should be paid by the medical insurance fund and the accumulated expenses incurred this year after the amount within the medical insurance scope is decomposed according to the policy and the identity of the insured;

"This personal burden" refers to the total amount of expenses that are not paid by the medical insurance fund, including the amount outside the scope of medical insurance and the amount paid by individuals within the scope;

"Personal cash payment amount" refers to the personal burden amount that the insured needs to pay in cash;

"This year's accumulated payment of large-scale outpatient medical mutual fund" refers to the total amount of large-scale outpatient medical mutual fund of medical insurance paid by the insured in a natural year;

The total medical expenses of this medical treatment = "this medical insurance fund payment"+"this personal burden".

14. Is there any change in the current outpatient deductible policy after seeing a doctor?

The outpatient deductible standard has not changed. The insured only deducts the deductible once a year, for employees 1.800 yuan and retirees 1.300 yuan. The medical expenses below the deductible line are paid in full by the individual, and the medical expenses above the deductible line are only paid by the individual according to the reimbursement ratio stipulated by the policy.

15. How to understand the relevant policies of social security card medical treatment?

Insured persons who are not familiar with the policy of "real-time settlement of medical treatment by card" can call the human resources and social security consultation telephone number 12333 (local call charge only) for details, and call the service hotline 96 102 (local call charge only) for social security card information.