How to reimburse medical insurance card for hospitalization, and how much can be reimbursed?

Almost everyone has a medical insurance card. Everyone knows that a medical insurance card can be used not only to buy medicines at designated pharmacies, but also to reimburse hospitalization expenses. However, few people can answer specific questions such as how to use and detailed vouchers. I specially consulted the documents of social security bureaus all over the country to find the answer. How to reimburse the hospitalization medical insurance card organized by netizens? How much can I reimburse? Relevant information is for your reference.

How to reimburse the medical insurance card for hospitalization?

Q: How can I be reimbursed for hospitalization in a designated hospital in the city?

Answer: Bring my ID card and copy, my social security card (medical insurance card), go through the online inspection and registration procedures in the inpatient department of my hospital within 2 days of admission, and immediately reimburse me when I leave the hospital. Expenses that meet the requirements of medical insurance policies shall be reimbursed according to the following policies.

Q: How to reimburse the referral of serious diseases and incurable diseases to higher-level hospitals?

Answer: You must go through the referral examination and approval procedures at the business hall window of the medical insurance department with the Approval Form for Referral issued by designated hospitals with referral qualifications (such as Huantai County People's Hospital and Zibo Central Hospital) and the ID card of the insured. For those who go through the referral procedures and go to the appointed hospital for medical treatment, the medical expenses in line with the policy shall be borne by the individual15%; If you go to a non-agreement hospital for medical treatment, you should pay 30% of the medical expenses that meet the policy first. For those who have not gone through the referral procedures, 40% of the medical expenses in line with the policy shall be borne by the individual. The balance that meets the policy requirements after personal burden shall be reimbursed according to the hospitalization policy of this Municipality.

Q: How to reimburse for long-term hospitalization in other places?

Answer: Go to the Medical Insurance Office to get the registration form of residence in different places or download it from the website of the County People's Social Security Bureau, and go through the resettlement procedures at the lobby window of the Medical Insurance Office.

Hospitalization under special circumstances

Under special circumstances, such as traveling in different places, doing business, visiting relatives, etc. , due to sudden acute, dangerous, serious illness in different places, should be to the local basic medical insurance designated state-owned medical institutions for hospitalization, shall be within 3 days (in case of legal holidays, calculated on schedule) to call the medical insurance agencies under their jurisdiction for the record. Hospitalization expenses are paid in advance by personal cash at the time of discharge.

How much can medical insurance card be reimbursed for hospitalization?

Because the economic level of each city is different, the hospitalization treatment in each city is different. Please consult the local social security bureau for details.

Wuxi, Jiangsu

Employee social insurance reimbursement

1, hospitalization expenses according to regulations:

Tertiary hospitals: tertiary medical institutions are discharged, and the medical expenses are below 6,543.8+0,000 yuan (including 6,543.8+0,000 yuan), with 84% paid by the on-the-job staff's overall fund and 654.38+0.6% paid by individuals; Medical expenses 1 10,000 yuan to 40,000 yuan (including 40,000 yuan), 88% paid by the overall fund, and the individual pays 1.2% (the individual pays 50% of the above standard, the same below);

Hospitals below the second level: in the first and second level medical institutions, the medical expenses of employees are below 1 10,000 yuan (including 1 10,000 yuan), 88% is paid by the overall fund, and the proportion of individual self-payment is12%; Medical expenses 1 0,000 yuan to 40,000 yuan (including 40,000 yuan), 90% paid by the overall fund, and 0/0% paid by individuals (50% paid by retirement);

Community hospital: discharged from the community health service center, the medical expenses are below 40,000 yuan (including 40,000 yuan), 92% is paid by the overall fund, and 8% is paid by the individual (half is paid for retirement);

2. Large expenses: the proportion of medical expenses above 40,000 yuan paid by the fund and paid by individuals is 92% and 8% respectively.

3. initial hospitalization fee: the first hospitalization fee (threshold fee) is required. The tertiary hospital is working in 950 yuan and retiring in 750 yuan; The second-level hospital is working in 750 yuan, retiring 600, the first-level hospital is unified as 400 yuan, and the community health service center is unified as 300 yuan. During the year, the second hospitalization was 50% of the above standard, and the third and above hospitalization was 25% of the above standard.

Resident social security reimbursement

The first visit should be in the community health service center. The starting cost of hospitalization medical expenses is 200 yuan, 90% of which is paid by eligible medical expenses fund, and 10% is paid by individuals. Transferred to other medical institutions in the urban area, the initial hospitalization expenses for students and children are 300 yuan, and other residents are 600 yuan. If they are hospitalized in medical institutions below the second level, they will be paid according to 75% of the prescribed medical expenses, 25% for individuals, 65% for the funds of tertiary medical institutions, 35% for individuals, 55% for individuals transferred from the urban area, and 45% for individuals. If the transfer procedures are not handled according to the regulations, the fund will pay 50% of the above standards.

Maximum limit: the maximum annual cumulative medical expenses of residents' basic medical insurance is 200,000 yuan. If the insured residents have paid for 5 years or more continuously, the maximum annual accumulated medical expenses will be increased by 50,000 yuan on this basis; The residents' medical insurance fund will no longer pay the part above the maximum annual accumulated medical expenses.

The medical expenses for outpatient special disease treatment are 90%, and the annual maximum amount is combined with the general hospitalization medical expenses.

abstract

If you are hospitalized in this city, you can directly settle the reimbursement in the hospital after discharge. If you are hospitalized in a different place, you need to pay in advance and then go to the Social Security Bureau for reimbursement. The reimbursement rate for hospitalization should be at least 50%.

The above data are compiled according to the information published online, and the specific policies are subject to the implementation of the final document. You can also call the local social security bureau at 12333 for free consultation.