New rules for reimbursement of Sanming medical insurance in different places

Sanming medical insurance reimbursement in different places specific provisions are as follows:

1, if expensive medicine, special examination and special treatment, 70% will be reimbursed; Class B drugs are calculated at 80%; 88% of the threshold fee is more than 3,000 yuan; 3000-5000 yuan is 90%; 5000- 10000 yuan is 92%; 10000 yuan to 95% of the maximum payment limit.

2. There are two kinds of reimbursement for medical treatment in different places: one is that the hospital where the insurance is located has opened the procedures for transfer treatment, and the other is emergency treatment in different places. The proportion needs to be consulted with the local medical insurance department, which is usually not much different from the local medical care. Self-funded drugs and inspection fees can't be reimbursed anywhere.

3. Need to take to the local hospital for treatment of emergency certificate, copy of hospitalized cases, discharge department need to be confirmed by the hospital seal, medical invoices, drugs, checklists should also be brought.

Medical insurance reimbursement process in different places:

1, the first is the referral certificate of the hospital at or above the county level. Take the medical insurance in a small town as an example. If you want to go to a different place for medical treatment, you must first go to a hospital at or above the county level. Generally, there will be county-level hospitals in the town, allowing doctors to issue referral certificates;

2. Stamp the social security window of the hospital. The social security window of the hospital will generally be located at the toll gate, and it will be handled by the referral certificate;

3. Go to the local social security office to register for out-patient treatment. There are social security offices in general towns, and the address of the social security office can be found;

4. After going out for treatment, get it back to the county-level social security bureau for reimbursement. After completing the above three steps, you can go to a hospital in a big city. Wait until you have cured the invoices, medical books, social security cards and household registration books, and then wait until the higher social security bureau reimburses them. If it's just an outpatient clinic, you don't need these procedures. Just go outside to see the doctor first, and then come back to the social security bureau for reimbursement after reading it.

To sum up, medical treatment in different places first needs to be approved by relevant departments. The examination and approval place for resettlement in different places is the county medical insurance center where the insured unit or street social security is located. After applying for the relevant approval form, fill in the relevant contents. Take the relevant documents to the medical insurance department of a different hospital and stamp them. Then return the relevant approval form to the applicant for approval.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.