Luoyang medical insurance reimbursement process How to reimburse Luoyang medical insurance?

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Reimbursement of hospitalization medical expenses:

Qifubiaozhun: a first-class hospital 100 yuan; 400 yuan, a secondary hospital; 600 yuan, a tertiary hospital; Family sickbed 100 yuan;

Qifubiaozhun for the number of hospitalizations: for the second hospitalization within one medical insurance year or later, Qifubiaozhun will be halved;

Reminder: within 30 days, if you are hospitalized for the second time due to the same disease, you will only pay the minimum compensation once; /kloc-children under 0/4 years old are hospitalized, and the minimum threshold is halved;

Reimbursement ratio: 80% for first-class hospitals; 70% of secondary hospitals; 60% of tertiary hospitals; Family sickbed 60%;

Outpatient medical expenses reimbursement:

General outpatient treatment standard:

All insured residents enjoy general outpatient treatment. In a medical insurance year, there is no deductible line for general outpatient service, and the medical expenses within the scope of outpatient co-ordination fund are reimbursed at a rate of 50%;

Criteria for outpatient treatment of special diseases:

Answer: For outpatient diseases of the following special diseases, the medical expenses that meet the payment scope of the overall fund will be reimbursed at the rate of 60%:

Chronic renal failure dialysis;

Radiotherapy and chemotherapy for malignant tumors;

Chemotherapy for tuberculosis;

Anti-rejection of organ transplantation;

Hemophilia;

Interferon treatment of hepatitis C;

Outpatient rehabilitation treatment;

Hand, foot and mouth disease in children;

Medical expenses for rescuing death in outpatient department.

B: For outpatient diseases of the following special diseases, the medical expenses that meet the payment scope of the overall fund shall be reimbursed according to the quota standard:

Non-dialysis treatment of chronic renal failure, non-dialysis treatment of chronic renal failure+diabetic complications,

Non-dialysis treatment of chronic renal failure+rheumatic diseases;

Schizophrenia, depression, severe refractory obsessive-compulsive disorder;

Diabetic complications;

Heart failure above degree Ⅱ;

Aplastic anemia and myeloproliferative diseases;

Systemic lupus erythematosus, ankylosing spondylitis, systemic sclerosis, polymyositis, rheumatoid arthritis and primary Sjogren's syndrome;

Laser treatment of fundus hemorrhage;

Anticoagulant therapy after arterial stent, heart valve replacement or bypass surgery;

Decompensation of cirrhosis;

Phacoemulsification of cataract;

Pituitary tumor and hypothyroidism;

Chronic glomerulonephritis, nephrotic syndrome;

Nephropathy+diabetic complications;

Type I diabetes;

Chronic obstructive pulmonary disease;

Autoimmune hepatitis;

Hypertension stage ⅲ;

Parkinson's syndrome.

The centrally identified 12 diseases include: diabetic complications, heart failure above degree II, type I diabetes, chronic obstructive pulmonary disease, decompensation of liver cirrhosis, renal diseases, non-dialysis treatment of chronic renal failure, rheumatic diseases, hepatitis C, hypertension III, hemophilia and Parkinson's syndrome. The social insurance department organizes an appraisal once a month. Insured residents can apply for appraisal consultation in the service halls of 17 and 18 on the second floor of the Municipal Social Insurance Administration, the service halls of Jianxi, Xigong, Old Town, Hehe and Geely Social Insurance Centers, and the service hall on the first floor of the Health Insurance Department of China Life Luoyang Branch.

Serious illness medical expenses reimbursement:

The medical expenses incurred by the insured residents in a single hospitalization belong to the part within the scope of payment of the basic medical insurance fund for urban residents. After the basic medical insurance fund is paid in proportion, the personal burden exceeds 8,000 yuan, and the serious illness insurance fund gives "second reimbursement" to the excess part according to the proportion of 55%;

For the medical expenses incurred by insured residents in hospitalization for many times within one year, after the basic medical insurance and "second reimbursement" are paid, the accumulated hospitalization medical expenses of individuals within one year exceed 25,000 yuan, and the excess part is compensated by the serious illness insurance fund according to the proportion of 55%. The annual maximum payment limit of the serious illness insurance fund is 250,000 yuan.

Urban workers

Reimbursement of hospitalization medical expenses:

Qifubiaozhun for hospitalization is:

Level-I hospital: 240 yuan for the first time, 20 yuan for the second time, and Kloc-0 for the third time and later/20 yuan;

Secondary hospital: first hospitalization in 480 yuan, second hospitalization in 360 yuan, third hospitalization and later 240 yuan;

Tertiary hospitals: first hospitalization in 600 yuan, second hospitalization in 480 yuan, third hospitalization and later 360 yuan;

Third-class first-class hospital: first hospitalization in 800 yuan, second hospitalization in 600 yuan, third hospitalization and later 480 yuan;

Note: Minimum threshold of family sickbed 120 yuan.

Reimbursement ratio:

1, 10000 yuan or more: 80% for employees in tertiary hospitals and 85% for retirees; 85% of employees in secondary hospitals are reimbursed and 90% of retirees are reimbursed; 90% of employees and 95% of retirees in first-class hospitals are reimbursed;

2. The minimum payment standard is more than RMB 10000: 85% for employees in tertiary hospitals and 87% for retirees; 90% for employees in secondary hospitals and 92% for retirees; 95% of employees and 97% of retirees in first-class hospitals are reimbursed;

Outpatient medical expenses reimbursement:

The management of basic medical insurance for urban workers, special medical care and special outpatient diseases shall be implemented in accordance with the unified provisions of the whole city.

Reimbursement scope

Medical insurance expenses are not reimbursed:

Clear medical expenses paid by the industrial injury insurance fund;

Traffic accidents, accidents, medical accidents, etc. It is obviously the responsibility of a third party;

Should be borne by public health;

Go abroad for medical treatment;

Other expenses that shall not be paid according to laws and regulations.

Processing time limit and cost

Time limit for processing: after approval, it will be processed immediately.

Handling fee: no charge.

Processing address

Luoyang social insurance enterprise management bureau

Tel: 0379-632 19526

Address: Floor 2, Luoyang Convention and Exhibition Center, No.286 Kaiyuan Avenue

Luoyang society insurance enterprise management bureau service hall

Address: Northeast corner of Kaiyuan Avenue intersection, Xuefu Street, Luolong District, Luoyang, Henan Province

Luoyang social security bureau society insurance operating service hall

Address: Xigong District, Luoyang

Jin Meng county society insurance enterprise management bureau

Address: Near No.333 Xiaolangdi Road