Measures of Linxia Municipality on Reimbursement of Medical Insurance

Medical insurance is divided into two accounts, personal account and medical insurance card. The money can be used to buy medicine at designated pharmacies, pay outpatient expenses and pay the part of hospitalization expenses that the individual pays. The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account.

When seeking medical treatment (hospitalization), show the medical insurance card to the designated hospital to prove the identity of the insured. At the time of checkout, the part paid by the individual is paid by medical insurance card or cash, and the part reimbursed by medical insurance is settled by medical insurance and hospital, so the individual does not need to pay first and then reimburse. Medical expenses of outpatients cannot be reimbursed.

How to reimburse social medical insurance?

The reimbursement ratio of different medical insurance in different hospitals is different: if a person spends 10000 yuan in a hospital, if he is hospitalized in a first-class hospital, 500 yuan will be deducted first; If you are hospitalized in a secondary hospital, first subtract 1000 yuan; If you are hospitalized in a tertiary hospital, you will be reduced by 2000 yuan first; After excluding "non-medical insurance drug expenses" and "other non-medical insurance expenses", the remaining employees reported 80%, retired or unemployed, and unemployed 50%. (Note: Medical insurance reimbursement only covers Class A drugs, that is, medical insurance drugs, and Class B drugs are not covered by medical insurance and cannot be reimbursed)

In-service employees' reimbursement rate for hospitalization medical insurance hospitalization, except for the self-funded part and the self-paid 10% of class B expenses, the part exceeding the hospital medical insurance deductible line enjoys the proportion of overall payment, and the proportion of overall payment is different at different hospital levels. The proportion of medical insurance for employees is over 80% (82%/84%/87% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan).

The social security card has not adjusted any medical reimbursement ratio. According to the Regulations of Beijing Municipality on Basic Medical Insurance issued in 2005, the social supplementary medical insurance for retirees under 70 years old is 50%. Payment institutions need to prepare copies of medical insurance manuals, medical bills, receipts and details when handling reimbursement procedures. For details, please also consult the labor security telephone number 12333.