Proportion of reimbursement for medical insurance card pharmacies

The proportion of reimbursement for drug purchases in pharmacies varies according to the types of drugs purchased.

Medical insurance can be reimbursed if the cost of drug purchase is within the scope of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards. The parties can bring their own social security cards and other information and go directly to the pharmacy for settlement.

Social security card to the pharmacy to buy medicine is a way of medical insurance outpatient expenses.

1, reimbursement ratio of employee medical insurance outpatient service:

After the on-the-job employees see a doctor in the outpatient and emergency department of the hospital, the medical expenses of more than 2,000 yuan can be reimbursed, and the reimbursement ratio is 50%. For retirees under 70 years old, expenses above 1300 yuan can be reimbursed, and the reimbursement rate is 70%. For retirees over 70 years old,180% of the expenses above 300 yuan can be reimbursed. No matter what kind of people, the maximum payment limit for outpatient and emergency medical expenses is 20 thousand yuan.

2, residents' medical insurance outpatient reimbursement ratio:

Outpatient settlement procedure: Insured patients will pay the medical expenses incurred in the outpatient service of designated medical institutions directly by swiping the card at the resident medical insurance settlement counter with the special medical insurance prescription and social security card. In an insurance year, if the total outpatient expenses are below 50 yuan, the medical insurance fund will pay 40%, and the expenses above 50 yuan will be borne by individuals.

The reimbursement process of medical insurance pharmacy:

1, the insured person carries personal ID card, medical insurance card, expense invoice, medication list and other related materials to the medical insurance department for reimbursement procedures;

2, in line with the basic medical insurance drug list, be reimbursed from the basic medical insurance fund.

The medical expenses that should be paid by the basic medical insurance fund shall be directly settled by the pharmaceutical business unit.

Legal basis:

People's Republic of China (PRC) social insurance law

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.