What is the reimbursement scope of social security card?

Social security reimbursement refers to the behavior of social insurance to compensate employees and residents for medical expenses, maternity expenses and work-related injury treatment expenses in proportion. Social security reimbursement mainly includes maternity insurance reimbursement and work-related injury insurance reimbursement. The reimbursement methods of social medical insurance vary from place to place.

Social security card reimbursement scope:

I. Outpatient service

1. Reimbursement scope: general outpatient and emergency expenses incurred by the insured in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by the insured.

2. Outpatient deductible line: the total emergency expenses of general outpatient service exceed 1.800 yuan in a natural year.

3. Reimbursement ratio: 70% for the hospital and 90% for the community, and 20,000 yuan for the part above 1.800.

4. Required materials: original ID card; Original medical diagnosis certificate; Original medical data such as outpatient medical records, examination and test results reports; Original receipt of general outpatient and emergency charges; The original of the detailed list of outpatient expenses or prescription (the prescription is pasted on the back of the receipt by date).

5. Submission time: every month 1- 10, the expenses of the current month shall be submitted the next month, and the expenses of the current year shall be submitted before 1 the following year.

6. Handling process: If the accumulated Qifubiaozhun exceeds the Qifubiaozhun in a natural year, the unit manager will input all the documents into the enterprise software and report the generated electronic information and statements to the medical insurance center, which will complete the review, settlement and payment of reimbursement expenses within 30 working days.

Second, hospitalization.

1. Reimbursement scope: hospitalization expenses incurred by the insured in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by the individual.

2. Inpatient deductible line: The standard of the first hospitalization deductible line in a natural year is 1.300 yuan, with 650 yuan as the unit each time.

3. Reimbursement ratio: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total reimbursement of 300,000 yuan for hospitalization.

4. Handling process: Please use the Beijing Medical Insurance Manual for medical treatment. If the unit pays in full, the individual can go through the hospitalization formalities only by paying part of the hospitalization advance payment, and the medical expenses incurred should meet the scope of medical insurance. When leaving the hospital, the hospital and the individual will settle the expenses themselves, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center.

Extended data:

The Social Security Card of the People's Republic of China is an integrated circuit (ic) card, which is uniformly planned by Ministry of Human Resources and Social Security and issued to the public by local human resources and social security departments, and used in various business fields of human resources and social security.

Social security cards have a wide range of functions. Cardholders can not only use the card for real-time settlement of medical insurance personal accounts, but also handle endowment insurance affairs; Go through the formalities of job registration and unemployment registration; Apply for unemployment insurance; Apply for employment training; Apply for labor ability appraisal and enjoy work-related injury insurance benefits; Handling labor and social security affairs online.

The social security card adopts the national unified standard, and the social security number adopts the citizenship number in accordance with the relevant provisions of the Social Insurance Law.

By the end of 20 16, the number of social security card holders in China has reached 972 million, and the social security card will basically realize the national one-card system in 20 17.

References:

Baidu encyclopedia-social security card