I've only paid into my social security for one year, how do I get reimbursed for hospitalization expenses?

Medicare reimbursement is available for hospitalization expenses if you have paid for 1 year.

Medicare reimbursement includes full reimbursement for Class A drugs, full out-of-pocket expenses for Class C, and 80% reimbursement for Class B, with a 20% out-of-pocket rate. Out-of-pocket expenses are not reimbursed, and there is a limit on the cost of beds. The total is usually about 70 percent.

Medicare hospitalization reimbursement process is as follows:

First of all, in the beginning of the hospitalization should be with the hospital to explain that they are reimbursed by the medical insurance, but to advance the medical expenses, and then you can take the invoice to the medical insurance settlement window to reimbursement.

Paying for your hospitalization with your personal account on your health insurance card, you can tell the hospital's billing staff before you're discharged, and you can do it according to the normal procedures for swiping your card. You can't use your personal account to pay for out-of-pocket expenses.

The settlement of hospitalization expenses is based on the post-payment method of service items.

Extended Information:

p>This refers to the reimbursement by social insurance of a percentage of the cost of medical expenses, maternity expenses and treatment of work-related injuries of employees and residents. Social security reimbursement mainly consists of three parts: maternity insurance reimbursement and work injury insurance reimbursement. Social health insurance reimbursement methods vary somewhat from place to place.

Basic Introduction

It refers to the act of proportionally reimbursing employee residents' medical expenses, maternity expenses and work injury treatment expenses by social insurance.

Insurance Treatment

Medical Reimbursement

I. Outpatient Clinic

(1) Use of the medical insurance card for outpatient clinic visits will be settled in real time without reimbursement.

(2) If you visit the outpatient clinic without a medical insurance card, please use the Beijing Medical Insurance Handbook (medical blue book).

1. Scope of reimbursement: general outpatient and emergency expenses incurred by the insured person at the medical insurance designated hospitals or specialized hospitals of his/her choice, Chinese medicine hospitals and Class A hospitals.

2. Outpatient starting line: general outpatient and emergency expenses incurred in a natural year exceeding 1,800 yuan in total.

3. Reimbursement rate: 70% for hospitals and 90% for communities for the portion above 1800 yuan, and the ceiling line: 20,000 yuan.

4. Required materials:

Original ID card;

Original medical diagnostic certificate;

Original medical documents such as outpatient medical records, report cards of examination and test results;

Original receipts of fees for general outpatient and emergency treatment,

Original list of outpatient expenses or original prescriptions (the prescriptions are attached to the back of the receipts according to date). ).

5. Submission time: 1-10th of each month, the current month's fees to be submitted the following month, the current year's fees need to be submitted by January of the following year.

6. Process: If the total amount exceeds the starting standard in a natural year, the unit operator will enter all the documents into the enterprise version of the software, and report the generated electronic information and statements to the medical insurance center, which will complete the audit, settle the accounts, and pay the reimbursement fees within 30 working days.

II. Hospitalization

1. Reimbursement scope: hospitalization expenses incurred by insured persons at the designated hospitals or specialized hospitals of medical insurance of their choice, Chinese medicine hospitals and Class A hospitals.

2. Starting line for hospitalization: the starting line for the first hospitalization in a natural year is 1,300 yuan, and 650 yuan for each subsequent hospitalization.

3. Reimbursement rate: 90% for Class I hospitals, 87% for Class II hospitals, 85% for Class III hospitals, and a cumulative reimbursement of 300,000 yuan for hospitalization.

4, the process: please use the "Beijing Medical Insurance Manual" when seeking medical treatment, if the unit pays in full, the individual only needs to pay part of the hospitalization advance payment, you can apply for hospitalization, the medical expenses incurred should be in line with the scope of medical insurance, the hospital and the individual when discharged from the hospital to clear the amount of out-of-pocket expenses, the amount of reimbursement of the integrated fund by the hospital and the district medical insurance center.

Reference:

Baidu Encyclopedia - Social Security Reimbursement