Social Security In 2023, what is the scope of reimbursement for Handan social security card and the proportion of reimbursement for medical treatment in Handan hospital?

I compiled the reimbursement scope of Handan social security card and the reimbursement ratio of Handan hospital. Social security cards have a wide range of functions. Cardholders can not only use the card for real-time settlement of medical insurance personal accounts, but also handle endowment insurance affairs; Apply for job registration and unemployment registration ... I want to know more about the reimbursement scope of Handan social security card and the reimbursement ratio of medical treatment in Handan hospital. Let's have a look.

The scope of reimbursement for Handan social security card and the proportion of reimbursement for medical treatment in Handan hospital were compiled through collation.

Social security cards have a wide range of functions. Cardholders can not only use the card for real-time settlement of medical insurance personal accounts, but also handle endowment insurance affairs; Go through the formalities of job registration and unemployment registration; Apply for unemployment insurance; Apply for employment training; Apply for labor ability appraisal and enjoy work-related injury insurance benefits; Handling labor and social security affairs online.

Handan social security card reimbursement scope

Unified payment per person per year 150 yuan.

Medical insurance for urban and rural residents shall be paid according to the natural year. Every year from September 1 to February 20th, 12 is the payment period for the next year. Insured residents who go through the insurance payment procedures within the specified time shall enjoy the corresponding medical insurance benefits for urban and rural residents from June 65438+1 October1day to February 3 1 day of the following year. Urban and rural residents who have not paid fees do not enjoy medical insurance benefits for urban and rural residents.

It is worth noting that the integrated medical insurance for urban and rural residents no longer distinguishes between payers, and the individual payment standard for urban and rural residents is unified as per person per year 150 yuan. After the expiration of the insurance payment period, urban and rural residents who meet the insurance conditions can be insured halfway. Residents (excluding newborns) who are insured halfway need to pay the basic medical insurance premium including government subsidies in full, and can enjoy medical insurance benefits for urban and rural residents after 90 days from the date of payment. Medical expenses incurred during the unpaid period and within 90 days after payment shall not be paid by the medical insurance fund.

In addition, special people who enjoy full government subsidies, such as five-guarantee households, low-income households and severely disabled people who have lost their ability to work, do not pay fees, but are fully funded by the government.

Different people have different insurance and payment methods.

Scope and object of insurance: urban and rural residents with household registration in this city who have not participated in the basic medical insurance for urban workers; Non-local residents whose residence permits are issued by the public security organs of this Municipality; Students (hereinafter referred to as college students) in all kinds of full-time ordinary colleges and universities (including private colleges and universities) within the jurisdiction of this Municipality. At the same time, it is clear that those who participate in medical insurance for urban and rural residents may not participate in medical insurance for urban workers at the same time, and may not enjoy medical insurance benefits repeatedly.

Urban and rural residents who meet the conditions of insurance shall go through the insurance registration formalities with the family (household) as the unit, and go to the village (neighborhood) committee (community) where the household registration book and ID card are located (residence of the residence permit holder). After the insurance registration, the payment procedures shall be handled within the prescribed time limit.

Primary and secondary school students and kindergartens in Cangzhou city can take schools or kindergartens as units, and the schools or kindergartens can handle the insurance payment procedures in a unified way. Those who have been insured with their families are no longer insured.

College students are unified by their universities to the local county (city, district) agencies to handle the insurance payment procedures.

Members with the same household registration who meet the insurance conditions must be insured at the same time and cannot be selectively insured. Family members who have participated in employee medical insurance or medical insurance for foreign residents may not participate in medical insurance for urban and rural residents in this city with their household registration, but they need to provide insurance payment vouchers or relevant certificates.

The specific payment method is: rural residents are collected and remitted by the village Committee; Urban residents pay fees at designated bank outlets; Students in school are collected and remitted by their school.

Proportion of reimbursement of medical expenses in Handan hospital

Newborns can be insured at any time.

Newborns are registered in the medical insurance center where their household registration is located, and pay the individual contribution part of the annual medical insurance premium within 90 days from the date of birth, and enjoy the medical insurance benefits of residents from the date of birth. If you go through the formalities of insurance payment after 90 days of birth, you will enjoy the medical insurance benefits for residents from the next month of payment.

If the newborn goes through the insurance payment procedures within 90 days after birth, after paying the medical insurance premium for two years according to the prescribed standards, it will enjoy the corresponding residents' medical insurance benefits within two years from the date of birth.

Insured residents can enjoy general outpatient treatment and chronic disease outpatient treatment.

General outpatient medical expenses are allocated to individuals for one-time use according to the standard of 50 yuan per person per year, which is mainly used to pay outpatient medical expenses in designated township hospitals, village clinics and community health service institutions. The year-end expenses are not clear, and can be carried over to family members for use.

Insured residents suffering from 20 kinds of chronic diseases, such as hypertension (high risk of stage III and above), cor pulmonale and sequelae of cerebrovascular disease (with serious dysfunction), can report chronic outpatient diseases to the township (community) social security office before 1 1 month every year. After being recognized as qualified, the minimum payment standard for medical expenses incurred by chronic outpatient diseases in designated medical institutions is 200 yuan, and the reimbursement rate is 70%.

Insured residents can be hospitalized up to 90%

Insured residents in designated medical institutions in accordance with the provisions of the policy of hospitalization medical expenses, Qifubiaozhun below paid by individuals; The expenses above Qifubiaozhun and below the maximum payment limit shall be borne by the medical insurance fund and individual insured residents in proportion.

Qifubiaozhun for hospitalization: The Qifubiaozhun for the first hospitalization of insured residents in designated medical institutions in this city is township hospitals (community medical service centers) 100 yuan, first-class medical institutions in 300 yuan, second-class medical institutions in 500 yuan, third-class medical institutions 1800 yuan, and traditional Chinese medicine (integrated traditional Chinese and western medicine) is 3,000 yuan. For multiple hospitalizations within one year, the Qifubiaozhun for the second and above hospitalizations is reduced by 50% on the basis of the Qifubiaozhun for the first hospitalization.

The reimbursement rate of hospitalization expenses: township hospitals (community medical service centers) 90%, first-class designated medical institutions 85%, second-class designated medical institutions 75%, and third-class designated medical institutions 65%. The reimbursement rate of hospitalization expenses incurred by using proprietary Chinese medicines (except injections), Chinese herbal pieces, Chinese herbal preparations and appropriate technologies of Chinese medicine increased by 15%. The proportion of reimbursement approved for transfer to foreign medical institutions is 50%.

Insured residents can be reimbursed up to 450,000 yuan per year.

Within one year, the maximum reimbursement limit of basic medical insurance for insured residents is 6.5438+0.5 million yuan. After reimbursement by the basic medical insurance, the part of the compliance medical expenses borne by the individual that exceeds the deductible line of the critical illness insurance shall be reimbursed by the critical illness insurance for the second time.

The critical illness insurance deductible is 654.38 yuan+100000 yuan, 55% above the deductible to 30000 yuan (inclusive), 65% above 30000 yuan to 654.38 yuan+100000 yuan (inclusive), and 654.38 yuan+100000 yuan or more. The maximum reimbursement limit for critical illness insurance is RMB 300,000.

The basic medical insurance for urban and rural residents can be reimbursed up to 450 thousand yuan per person per year, and the medical expenses of major illness insurance for medical treatment in designated medical institutions in this city can be reimbursed and settled in one stop.

In addition, the insured can choose to go to any designated medical insurance hospital in this city with the social security card, and the medical expenses will be settled online when leaving the hospital. Insured residents only bear the personal burden, and the rest are settled by the medical insurance agencies and designated medical institutions at the place of medical treatment.

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