Beijing Children's Health Insurance Outpatient Reimbursement Rules

Beijing children's health insurance reimbursement can be divided into outpatient and hospitalization reimbursement, in which the outpatient reimbursement, the starting standard is 650 yuan, above the starting standard part of the reimbursement of 50%, a medical insurance year cumulative payment of up to 2,000 yuan; inpatient reimbursement, the starting standard is 650 yuan, the starting standard part of the reimbursement of 70%, a medical insurance year cumulative payment of up to 170,000 yuan.

1, the scope of reimbursement: the insured person in the individual choice of health insurance designated hospitals or specialized hospitals, Chinese medicine hospitals and hospitals of category A (Youyi, Xuanwu, Guang'anmen Traditional Chinese Medicine, Tongren, Concordia, Beihang Third Hospital, Peking University People's Hospital, Peking University, the first, Jishuitan, Chaoyang, Jiangong, Liangxiang) incurred in the general outpatient, emergency room expenses.

2. Reimbursement rate: for general outpatient and emergency expenses incurred in a natural year, if the total amount of such expenses incurred by an employee exceeds 2,000 yuan, the part of the large medical mutual fund above 2,000 yuan will be paid 50%, and the individual will pay 50% out of his/her own pocket. Retirees accumulated more than 1300 yuan, more than 1300 yuan part of the cloth over 70 years of age of the large medical mutual fund to pay 70% of the individual to pay 30%, more than 70 years of age of the large medical mutual fund to pay 80%, the individual to pay 20%. The maximum payment limit is 20,000 yuan in a natural year.

3, medical management: general outpatient, emergency expenses personal cash payment, incurred medical expenses to meet the scope of the three major catalog library of medical insurance, purchasing drugs should be in the designated hospitals to issue a special prescription and stamped with the special seal of medical insurance purchasing, and then go to the designated pharmacy to buy drugs.

4, the reimbursement process: a natural year cumulative more than the starting standard, the insured person will be submitted to the unit or social security office documents, the unit or social security office will be entered into the enterprise version of the documents, the electronic information and documents declared to the medical insurance center. The medical insurance center will complete the audit, settlement and payment within 15 working days.

5. Reporting materials: receipts for general outpatient and emergency treatment, medical insurance prescriptions (prescriptions with double scratching), and details of the costs of examination and treatment.

6, the declaration date: 1-20 days a month, the cost of the month the next month to declare, the current year costs need to be declared before January 20 of the next year.

Legal basis: "The State Council on the establishment of basic medical insurance system for urban workers decision" Third, the establishment of basic medical insurance co-ordination fund and individual accounts

To establish a basic medical insurance co-ordination fund and individual accounts. The basic medical insurance fund consists of a comprehensive fund and individual accounts. The basic medical insurance premiums paid by individual employees are all credited to their individual accounts. The basic medical insurance premiums paid by the employer are divided into two parts, one of which is used to establish the integrated fund and the other is transferred to the individual account. The proportion to be transferred to the individual account is generally about 30% of the employer's contribution, with the specific proportion to be determined by the co-ordinating area on the basis of the scope of payment of the individual account and the age of the employee, etc.