Proportion of hospitalization reimbursement for Jinhua medical insurance

Insurance Bian Xiao helps you answer, and more questions can be answered online.

1. When is a medical insurance settlement year?

A: Students in Jinhua City are from September of that year 1 to August of the following year1.

Second, how to go to the hospital for reimbursement?

Answer: Insured persons who normally enjoy the basic medical insurance benefits in Jinhua City will go to designated medical institutions in the city and pay directly by credit card with social security card. Medical expenses incurred by other designated medical institutions outside Jinhua City (only medical expenses incurred in hospitalization) shall be reimbursed by the municipal and district medical insurance agencies.

3. What should I do if I see a doctor during the loss reporting period of my social security card?

Answer: During the period when the social security card is lost, if it is an outpatient service, the outpatient expenses will be reimbursed to the municipal and district medical insurance agencies before June 20 in a medical insurance year; If you are hospitalized, you will go to the hospital for medical insurance with the social security card loss report, and pay in full when you leave the hospital. After receiving the card, go to the hospital for direct settlement and return the payment part of the medical insurance pooling fund.

4. What are the rules for the reimbursement time of medical expenses?

A: Reimbursement business is accepted on normal working days. Due to annual settlement, all invoices in one medical insurance year will be reimbursed before June 20th, and medical expenses incurred from June 20th to June 30th will be reimbursed in July of the next medical insurance year.

5. Can the pharmacy reimburse the cost of buying medicine?

Answer: When purchasing medicine in a pharmacy, the insured person holds a social security card and settles directly in the pharmacy, which is limited to personal accounts.

6. How to handle the transfer procedures?

Answer: If it is really necessary to be transferred to a third-class first-class hospital in Hangzhou or Shanghai for treatment due to the conditions of designated medical institutions in urban areas, the deputy director of the hospital and doctors above who are qualified for transfer should fill in the approval form for transfer, and the director of the department should sign the opinion, and the hospital medical insurance office and the medical department should review it, and after the signature of the dean in charge and the seal of the unit (urban and rural residents' neighborhood committees and student schools), they should go to the medical work injury and maternity treatment settlement office of Jinhua Social Security Bureau for review and handling. The application for transfer should be handled before admission, and if there are special circumstances, it should be handled within 7 working days after admission.

7. Which hospitals in Jinhua City can handle the transfer procedures?

Answer: Central Hospital, People's Hospital, Chinese Medicine Hospital, Guangfu Hospital, Second Hospital (mental illness), Wen Rong Hospital (kidney transplantation and pre-transplant examination) and Fifth Hospital (dermatosis).

8. Can I reimburse the medical expenses for going abroad to see a doctor?

A: The hospitalization expenses of normal insured payers are reimbursed, and there is no need to transfer to hospital for treatment, visit relatives or go out for other reasons. The visiting hospital is the designated hospital of local medical insurance, which belongs to the medical expenses paid by medical insurance. Individuals pay 20% first, and then enjoy the basic medical insurance benefits in Jinhua city.

9. What's the difference between hospitalization medical expenses reimbursement treatment for transfer and non-transfer?

Answer: When the insured person is approved to be transferred to another hospital, the individual will pay 10% of the medical expenses incurred in the local designated medical insurance, and then enjoy it according to the basic medical insurance benefits of Jinhua City. The medical expenses incurred in the local medical insurance designated hospitals without going through the transfer procedures shall be paid by the individual 20% first, and then enjoyed according to the basic medical insurance benefits of Jinhua City.

X. What are the special diseases?

Answer: Patients with malignant tumor, leukemia, aplastic anemia, chronic renal failure, uremia, organ transplantation and anti-rejection therapy, hemophilia, sequelae of cerebrovascular accident (this disease is limited to basic medical insurance for employees) and short stature (this disease is limited to minors).

XI。 What are the chronic diseases?

Answer: Hypertension II (with one of the complications of heart, brain and kidney), diabetes (with one of the complications of lower limb infection or heart, kidney, brain and eye), decompensation of liver function in liver cirrhosis, chronic active hepatitis, cardiac function above Grade III (inclusive), post-myocardial infarction (with one of the complications of cardiac insufficiency, angina pectoris and arrhythmia), chronic pulmonary heart disease and intractable asthma. Systemic lupus erythematosus (with one of the complications of heart, kidney, liver and nervous system), psychosis, pulmonary tuberculosis (active stage), rheumatoid arthritis, myasthenia gravis, Parkinson's disease, prostatic hyperplasia, hyperthyroidism, diabetes complicated with hypertension.

Twelve. How to apply for special (chronic) diseases?

Answer: Go to Jinhua Social Security Bureau or Medical Insurance Office of designated medical institutions to receive and fill in the Application Appraisal Form for Special (Chronic) Diseases of Jinhua Basic Medical Insurance, and fill in and provide relevant information according to the requirements of the form.

Thirteen, what information is needed to apply for special (chronic) diseases?

Answer: The diagnosis certificate (a hospital above Grade II), the discharge records related to the applied diseases or the original and photocopy of the outpatient medical records in the past six months (the photocopy needs to be stamped), and the laboratory and inspection data related to the applied diseases.

Fourteen, sporadic medical expenses reimbursement need to bring what information?

Answer: ● Information of reimbursement documents:

(1) General outpatient reimbursement: original invoice, medical record, prescription and expense list;

(2) Reimbursement for chronic diseases and special diseases: original invoices, special medical records for special (chronic) diseases, prescriptions and expense lists;

(3) Hospitalization reimbursement: the original invoice, discharge record, total expense list and transfer approval form of the transferred person, without the certificate or explanation of the transferred person; For medical treatment in other provinces, the certificate of designated medical institution issued by the local medical insurance agency shall be provided.

(4) If albumin, recombinant human erythropoietin, recombinant human granulocyte colony stimulating factor, recombinant human granulocyte macrophage colony stimulating factor and human immunoglobulin injection are used, relevant test reports shall be provided three days before administration.

● Reimbursement of identity information (original and photocopy provided):

(1) If it is handled by me, provide the social security card of the insured (or the medical insurance card, ID card and bank account of the insured);

(2) If the third party transfers the reimbursement treatment to the account of the insured, it shall provide the social security card of the insured (or the medical insurance card, ID card and bank account of the insured) and the ID card of the agent;

(3) If a third party handles reimbursement treatment and transfers it to a third party account, it shall provide the social security card (or medical insurance card and ID card of the insured), social security card (or bank account), ID card and the power of attorney of the client;

(4) For the guardian, provide the social security card of the insured (or the medical insurance card, ID card and bank account of the insured), the guardian's household registration book, ID card and social security card (or bank account);

(5) For the legal heir, provide the social security card of the insured (or the medical insurance card, ID card and bank account of the insured), the relationship certificate of the legal heir, ID card, death certificate or cremation certificate of the deceased and other related materials.

15. What medical treatment does the insured enjoy for hospitalization reimbursement?

Answer: In a medical insurance year, the insured person meets the prescribed hospitalization expenses, and the individual bears a certain amount (that is, the minimum deductible standard), and the minimum deductible standard for students and minors in school is halved. That is, 500 yuan, the downtown hospital; 350 yuan, three-level medical institutions such as Municipal Hospital of Traditional Chinese Medicine, People's Hospital, Second Hospital and Guangfu Hospital; 250 yuan, a secondary medical institution; A medical institution 150 yuan; 500 yuan, a designated medical institution outside the city. For the second and above hospitalization in the same medical insurance year, the Qifubiaozhun shall be calculated according to 50% of the Qifubiaozhun for the first hospitalization. The maximum payment limit for hospitalization year is 6.5438+0.5 million.

The medical expenses between the residents' Qifubiaozhun and the maximum payment limit shall be borne by the overall fund and the individual respectively, and shall be reimbursed by 85% in the first-class medical institutions-first-class payers, students and minors; 80% reimbursement for medical treatment in secondary medical institutions; 75% reimbursement for medical treatment in tertiary medical institutions; According to the standard two payment personnel (except for students and minors), 80% of them are reimbursed for medical treatment in a first-class medical institution; 70% reimbursement for medical treatment in secondary medical institutions; Third-level medical institutions are reimbursed 65% for medical treatment.

Sixteen, the insured general outpatient reimbursement enjoy what medical treatment?

A: 50% of the medical expenses are reimbursed in Jinhua City Community Health Service Center, and 20% of the medical expenses are reimbursed in medical institutions above Grade II (inclusive). In a medical insurance year, the maximum amount borne by the overall fund and individual in proportion is 1500 yuan. In other words, a medical insurance year can be reported to 750 yuan at most.

The general outpatient medical expenses incurred outside the urban area (except for resettlement in different places and transfer according to regulations) will not be paid by the overall fund.

Seventeen, the insured chronic disease outpatient reimbursement enjoy what medical treatment?

A: In a medical insurance year, the maximum amount borne by pooling funds and individuals in proportion is 2,000 yuan. The outpatient medical expenses for chronic diseases within the prescribed scope shall be reimbursed by the basic medical insurance pooling fund at 60%.

Eighteen, the insured special disease outpatient reimbursement enjoy what medical treatment?

A: The minimum threshold for an insurance year is 500 yuan. Medical expenses above the minimum deductible line shall be paid according to the hospitalization standard.

Nineteen, how to reimburse the outpatient expenses for students' accidents?

A: After an accident, students should call Jinhua Life Insurance Company to report it (955 19), and then report it to the life insurance company with valid documents such as medical records and invoices for outpatient medical expenses. Specifically, (1) outpatient medical insurance for accidental injuries is 10000 yuan, and outpatient medical expenses are paid at 90%; (2) The insurance amount for accidental injury and death is 100000 yuan; The amount of death insurance is 100000 yuan; (3) The amount of accidental injury and disability insurance is 65,438+000,000 yuan, which is paid according to the disability proportion listed in the Table of Disability Degree and Insurance Payment Proportion of Personal Insurance issued by the People's Bank of China. Reimbursement place: China Life Business Hall, No.633 1 Building, Danxi Road, Jiangnan, Jinhua City, with telephone number 82492849.

Medical expenses incurred by students in hospitalization in accidents must be reimbursed by Jinhua Social Security Bureau with discharge records, expense lists, invoices and certificates issued by the school medical insurance office. The telephone number of the reimbursement office of Jinhua Social Security Bureau is 0579-82822079, and the address of Jinhua Social Security Bureau is Public Administration Building, No.289 Danxi Road, Jinhua City.

20. What benefits can the insured who has purchased a large amount of supplementary medical insurance enjoy?

Answer: (1) Reimbursement treatment exceeding the maximum payment limit of basic medical insurance: The insured person's large supplementary insurance treatment is linked to the continuous purchase period, in the first year.

References: