How to reimburse Guangxi medical insurance

First, basic medical insurance benefits

(a) the source of personal account funds

1. All the basic medical insurance premiums paid by employees are included in personal accounts at 2% of their total wages.

2. 8% of the total wages of the basic medical insurance premium paid by the employer (6% in 2002) is included in the personal account according to the regulations, and the specific extraction method is 0.5% for people aged 45 and below; 46 to 59 years old1%; 60 years old and above 1.5%.

(B) the overall source of funds

The basic medical insurance premium paid by the employer, except that part of it is included in the personal account according to the regulations, the rest enters the basic medical insurance pooling fund.

(3) Payment scope of personal account

Personal accounts are mainly used to pay outpatient medical expenses that meet the basic medical insurance drug list and diagnosis and treatment items; Pay medical expenses that should be paid by individuals during hospitalization; Pay special examination and special treatment fees and outpatient medical expenses for some patients with chronic diseases.

(four) the scope of payment of the overall fund

1. Payment of hospitalization medical expenses: medical expenses that meet the requirements of basic medical insurance during hospitalization: above the minimum payment standard and below the maximum payment limit, shall be paid by the pooling fund according to the method of accumulation by stages, and individuals shall also pay a certain proportion:

Overall fund payment ratio% individual payment ratio%

On-the-job retirement of hospitalization medical expenses

The minimum payment is more than 5000 yuan 707520 15.

5000- 10000 yuan 7580 15 10

65,438+00,000 yuan to the maximum limit of 808,565,438+005.

2. The maximum payment limit of the overall fund within one year is 4 times the annual salary of employees. Medical expenses exceeding the maximum limit shall not be paid by the overall fund. The insured person pays in cash and solves it through commercial medical insurance.

Two. Interim Provisions of the State on Medicaid for Civil Servants

Scope of subsidies

1. List of medical expenses and drugs that meet the standards of basic medical insurance diagnosis and treatment items and medical service facilities.

2, more than the basic medical insurance fund to pay the maximum amount of medical expenses.

3, the basic medical insurance payment within the scope of individual pays a certain amount of medical expenses.

4, medical and health personnel in accordance with the provisions, enjoy the medical expenses of medical care.

5, in line with the national civil service Medicaid (public) injury. Maternity medical expenses.

(2) Outpatient Medicaid

A medical expense that meets the requirements of basic medical insurance:

On-the-job personnel are subsidized by 55% (the total outpatient medical expenses exceed 1600 yuan within one year).

Retirees' subsidy is 65% (total outpatient medical expenses exceed 1800 yuan within one year).

90% subsidy for medical staff (the total outpatient medical expenses exceed 2000 yuan in one year).

(3) Hospitalization allowance

1. Hospital bed fee subsidy: for the part exceeding the basic medical insurance bed fee 15 yuan, the daily subsidy shall be given to the working staff 10 yuan, retirees 15 yuan and medical staff 25 yuan.

2. The medical expenses incurred within one year of hospitalization for Class B drugs, Class B materials, Class B diagnosis and treatment items and accumulated personal out-of-pocket expenses above the threshold of the basic medical insurance pooling fund but below the maximum payment limit shall be subsidized according to: 85% of employees, 90% of retirees, 95% of medical staff and 100% of health care objects.

3. The subsidy standards for the use of drugs not listed in the basic medical insurance drug list during critical rescue are: 50% for employees, 60% for retirees and 90% for medical staff. This subsidy method is that doctors fill in the application form, report it to the medical insurance center for approval, and then settle it in cash, and submit the hospitalization invoice and application consent form to the medical insurance center for reimbursement according to regulations.

Third, the medical treatment of some outpatients with chronic diseases

1. Chronic diseases listed in outpatient service include coronary heart disease, diabetes, various malignant tumors, chronic obstructive emphysema, hypertension, Parkinson's syndrome, decompensated cirrhosis, uremia, chronic heart failure, and anti-rejection immunomodulation therapy after organ transplantation.

2. Each insured person can declare up to 3 diseases.

3 outpatient chronic diseases can only enjoy the list of medical insurance drugs within the prescribed scope of chronic diseases.

4, before entering the chronic disease subsidy, the individual pays the medicine fee below the Qifubiaozhun, which is 8% of the average annual salary of employees, and the rest of the medicine fee is paid by the overall fund in proportion.

Four, special inspection and special treatment project payment ratio

1. After the individual pays 40% of the expenses for special examination and special treatment according to the regulations, the remaining expenses shall be paid according to the proportion stipulated in the basic medical insurance, and the part paid by the individual shall be subsidized according to the proportion and limit of civil servants' subsidies.

2. For the use of imported materials and parts, 50% shall be paid by individuals in cash, and the rest shall be subsidized in the way specified in 1.

Verb (abbreviation of verb) Medical treatment of employees injured on business in central state organs and institutions directly under the permanent residence.

According to the spirit of Document No.9 of Medical Insurance of Guilao Society (2002):

1. Employees of institutions in directly under the authority, Central District who meet the conditions of enjoying the national civil servant Medicaid, and the medical expenses for work-related injuries that meet the requirements shall be reimbursed in the national civil servant Medicaid fund.

2. In case of work-related (work-related) injury accidents of employees in institutions in directly under the authority, Central District, they must report to the Medical Insurance Department of the Labor Department of the District by telephone within 48 hours, and fill in the report form of work-related (work-related) injury accidents of employees in units directly under the Central District in triplicate, and the employees identified as work-related injuries by the administrative department of labor and social security of the autonomous region shall enjoy medical treatment for work-related injuries according to regulations.

3. Employers and employees with work-related injuries shall provide the following certificates

Work-related (public) accident report form, designated hospital diagnosis certificate or occupational disease diagnosis certificate, relevant inquiry transcripts and circumstantial materials; In the event of a traffic accident, provide the traffic police department with materials such as accident handling responsibility letters.

4. After the staff and workers of the central authorities and institutions directly affiliated to Yong were injured at work (work-related injuries), the designated hospital is now the first affiliated hospital of Guangxi Medical University (including the second affiliated hospital, namely the West Hospital). Guangxi People's Hospital, Guangxi Workers' Hospital, Nanning Second People's Hospital. The critically ill can be rescued in the nearest hospital, and then transferred to the designated hospital for further treatment after the injury is stable.

5. During the medical treatment of work-related injuries, the basic medical insurance for urban workers in Guangxi Zhuang Autonomous Region, the scope of medical service facilities and payment standards, and the list of basic medical insurance drugs in Guangxi Province were implemented. During the rescue, the scope of medication can be appropriately relaxed, but it must be reported to the Social Security Bureau of the autonomous region for approval.

6, during the treatment of work-related injuries in accordance with the relevant provisions of the basic medical insurance hospitalization expenses, fully reimbursed in the national civil service Medicaid.

7. The outpatient and hospitalization expenses identified as work-related injuries (work-related injuries) shall be paid in cash by the unit first, followed by the work-related injury approval form, medical insurance certificate, hospitalization certificate and medical expenses list. Apply to the social security bureau of the autonomous region for review and reimbursement.

Six, personal medical insurance IC card management

1, personal medical insurance IC card records the insured's medical insurance files, personal account funds and usage, and is kept and used by individuals.

2. The principal and interest of an individual account are owned by the individual, and cash cannot be withdrawn in principle.

3. When the 3.IC card is lost or damaged, you should report the loss to the district medical insurance center with your personal ID card. If you fail to report the loss temporarily, you can call the district medical insurance center to report the loss in advance to avoid unnecessary losses. The telephone number for reporting the loss is 2853836.

Municipal medical insurance

A, outpatient medical specific projects

1. The specific project scope is: radiotherapy and chemotherapy for malignant tumor, dialysis treatment for uremia and anti-rejection treatment after organ transplantation.

2. For the insured who meets the specific items, the doctor shall submit a written application for each visit, and the expenses incurred after the examination and approval procedures shall be borne by the employees themselves (65,438+05%); Retirees bear 8% personally, and the rest is paid by the overall fund.

Insured persons over the age of 3.50, who suffer from serious chronic diseases in outpatient service within 30 days, and the accumulated medical insurance drug expenses exceed that of 500 yuan, shall be reimbursed according to regulations after reporting the drug expense reimbursement form to the municipal medical insurance center with the outpatient drug invoice and medical records.

Two, special inspection and special governance management and payment

1, for the special examination and treatment items approved by the application, the on-the-job personnel shall pay 30%; Retiree contribution 15%.

2, hospitalized patients due to illness, approved the use of imported artificial organs, the internal material costs paid by individuals in cash, and then by other relevant information to the city medical insurance center in accordance with the provisions of reimbursement.

Three, medical mutual payment treatment

1, if the employees participating in medical mutual aid pay more than the maximum amount of the overall fund, the excess medical expenses will be paid in cash, and the ticket holder will be reimbursed from the medical mutual aid fund according to the regulations.

2. The maximum amount paid by the overall fund is 4 times of the total average wages of employees in the previous year.

3, hospitalization expenses in the overall planning area in the first half of the average wage of workers within 9 times (including 9 times), medical mutual payment of 70%, the individual pays 30%; 80% of the average salary is more than 9 times 13 times (including 13 times), and individuals pay 20%; 90% average salary 13 times or more to 15 times, individual contribution 10%.

The basic medical insurance does not pay the scope of diagnosis and treatment projects are divided into the following categories.

I. Category of service items

1. Registration fee, out-of-hospital consultation fee, out-of-hospital consultation fee, urgent fee for examination and treatment, surcharge for roll call operation, and special medical service for self-invited nurses.

2. All kinds of beauty, bodybuilding and non-functional beauty and plastic surgery.

3. All kinds of weight loss, weight gain and height increase projects.

4. All kinds of health examination and medical appraisal fees.

2. Diagnostic equipment and medical materials

1. Electron emission tomography (PET) and ophthalmic excimer laser therapy were used.

2. Glasses, dentures, artificial eyes and hearing AIDS.

3. Various personal health care, massage, examination and treatment instruments.

Three. Treatment project

1. Organ source or tissue source of various organ or tissue transplants.

2. Transplantation of organs or tissues other than kidney, pericardium, cornea, skin, blood vessels, bone and bone marrow.

3. Orthopedic surgery for myopia.

4. Qigong, music therapy, spectrum therapy, laser therapy and light quantum therapy.

5 all kinds of infertility (pregnancy), sexual dysfunction, STD examination and treatment costs.

Four. Life service project

1. Transportation expenses for medical treatment, referral and first aid.

2. Hospitalization air conditioning fee, escort fee and nursing fee.

3. Expensive special services.

Verb (short for verb) others

1. Medical expenses (except rescue) incurred when not attending designated medical institutions.

2 without the approval of the relevant departments to the field of medical expenses.

3 foreign and Hong Kong, Macao and Taiwan medical expenses.

4. Maternity medical expenses for female employees (to be reimbursed separately according to the relevant policies on maternity).

5. Expenses arising from work-related (work-related injuries) (to be reimbursed separately according to relevant regulations on work-related injuries).

6 due to traffic accidents, medical accidents, suicide, self-mutilation, alcoholism, fighting and other medical expenses.

7. Wash teeth, extract teeth, and assemble artificial eyes and limbs.

8 "Guangxi Zhuang Autonomous Region basic medical insurance drug list" outside the drug costs.

9. Hospital-made drugs, self-defined items and new inspection and treatment items that have not been approved by health, drug supervision and management, price departments and district social security bureaus.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.