What is Zhuhai's medical insurance reimbursement policy?

Zhuhai Medical Insurance Reimbursement Process and Reimbursement Conditions 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.

Zhuhai Medical Insurance Reimbursement Ratio and Related Policies Medical Insurance Hospitalization Reimbursement Ratio

1. For the first-class insured persons of basic medical insurance, 92% of the employees pay and 94% of the medical insurance retirees pay;

2 basic medical insurance two insured pays 90%;

Among them, the one-time material cost with a unit price of more than 2,000 yuan shall be paid by the insured at his own expense, and the rest shall be included in the approved hospitalization medical expenses according to the proportion of 70%.

What materials should be submitted for reimbursement?

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.

The proportion of medical insurance reimbursement is as follows: 1. The amount of medical insurance reimbursement is: reimbursement amount = (total medical expenses-deductible-deductible) x reimbursement ratio, and the reimbursement ratio is about 85%. Second, if the medical expenses incurred by the parties exceed the maximum payment limit of the basic medical pooling fund, the social insurance department will reimburse 85% of the expenses below RMB 0-40,000, 90% of the expenses below RMB 40,000-80,000 and 95% of the expenses above RMB 80,000.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.