Is there a time limit for social security medical reimbursement?

There is a time limit for medical reimbursement. The policy of medical insurance reimbursement varies from place to place, but the basic rule is that it takes six months to one year from the date of expenses, and it is generally necessary to reimburse this year's medical insurance expenses before the end of the year. So let's bring the knowledge about the time limit of social security medical reimbursement. Please read and understand the article brought to you. 1. Is there a time limit for social security medical reimbursement? There is a time limit for medical reimbursement. The policy of medical insurance reimbursement varies from place to place, but the basic rule is that it takes six months to one year from the date of expenses, and it is generally necessary to reimburse this year's medical insurance expenses before the end of the year.

According to Article 8 of the Detailed Rules for the Implementation of the Social Insurance Law, if the medical expenses incurred by the insured in the agreed medical institutions meet the standards of the basic medical insurance drug list, diagnosis and treatment items and medical service facilities, they shall be paid from the basic medical insurance fund in accordance with state regulations.

If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.

Second, what percentage of medical reimbursement? Medical insurance card reimbursement is generally proportional, generally 60%-70%. In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur. The threshold for tertiary hospitals is 659 yuan, and the upper limit of reimbursement ratio is 50% 2000 yuan; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

3. What is the proportion of medical insurance reimbursement? Almost everyone knows that getting medical insurance does not mean that all medical expenses can be reimbursed, but there are not many details about the specific reimbursement amount.

The relevant person in charge of the Medical Insurance Department of Dongcheng District Labor and Social Security Bureau told the reporter that after getting medical insurance, if they are on-the-job employees, after seeing a doctor in the emergency department of the hospital, the medical expenses of more than 2,000 yuan can only be reimbursed, and the reimbursement ratio is 50%. For retirees under the age of 70, the 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. For example, if you are an on-the-job employee, and the outpatient medical expenses are 2,500 yuan, then this 500 yuan can be reimbursed 50%, that is, 250 yuan.

In case of hospitalization expenses, employees and retirees should pay the minimum amount 1300 yuan when using the basic medical insurance for the first time in a year. And the second and subsequent hospitalization medical expenses, Qifubiaozhun is determined by 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.

The reimbursement standard for hospitalization is related to the level of the hospital where the insured person is located. For example, in a tertiary hospital, employees have to pay 15%, that is, 85%, from the threshold to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals.

Almost everyone who goes to the hospital will encounter this situation. When registering and prescribing drugs, medical staff always ask patients whether they are insured or at public expense or at their own expense. Is it necessary to "look at people and eat vegetables" to see a doctor and take medicine? An ophthalmologist in a hospital who asked not to be named told reporters that generally speaking, the main reason for asking this question is that medical insurance participants can only be reimbursed if they consume drugs in the medical insurance catalogue. In the case of similar curative effect, try to choose drugs that can reimburse the insured. For out-of-pocket patients, there are more choices.

So, how are the drugs in the medical insurance catalogue determined? The reporter learned from the Medical Insurance Department of the Municipal Labor and Social Security Bureau that the drugs in Beijing's basic medical insurance catalogue are mainly drugs published by the Ministry of Labor, and Beijing has the right to organize experts to make adjustments according to the incidence of the city within the range of 15%. Generally speaking, the principle of selection is safety, reliability, reasonable cost and clinical necessity, while some drugs with high cost, big side effects and little clinical application are not listed in the catalogue, so patients can only use them at their own expense.

The relevant person in charge of the Medical Insurance Department of Dongcheng District Labor Insurance Bureau told the reporter that according to the relevant regulations, employees pay the basic medical insurance premium at 2% of their average salary in the previous year. After the insured person joins the medical insurance, he will get a current passbook of Bank of Beijing, and all the 2% basic medical insurance paid by the individual will be credited to his personal account. Generally, the money for going to the clinic to see a minor illness is from the personal account, and the money in the personal account can be freely controlled by the individual. In principle, it is used to pay daily small medical expenses and medical expenses that should be paid by individuals according to regulations. Its interest is calculated according to the deposit rate of residents in the same period, but the state does not levy interest tax on the deposits in the account. Therefore, the insured can only withdraw money from this account, not save money.

I believe that after reading the above introduction, you should know that patients have a time limit for medical reimbursement, and they need to be reimbursed according to relevant laws and regulations and their actual situation, so as to be effective. The above is about whether there is a time limit for social security medical reimbursement. I hope I can help you.