Guidelines for handling medical insurance reimbursement for Bengbu residents: cash reimbursement undertaking department
The cash reimbursement business of urban medical insurance is managed according to the location of the insured, and the urban medical insurance department of each branch of the municipal social insurance fund management is responsible for it.
Reimbursement conditions
1. The applicant has gone through the insurance formalities and paid the medical insurance premium in full.
2, cooperative medical designated medical institutions for medical treatment;
3. The medical expenses incurred by the insured in hospitalization in medical institutions shall be paid in cash in advance, and relevant documents and materials shall be kept.
Handling materials
1, original charge receipt;
2. Detailed list of expenses;
3. Outpatient medical records;
4. Proof of disease diagnosis;
5. Social security card;
6. Identity card;
7. Bank account.
Treatment process
The applicant submits the application materials.
Place of submission: Medical Insurance Section of Social Security Sub-bureaus of the Social Insurance Fund Administration where the insured is located.
The Social Insurance Fund Administration accepts applications.
1. The accepting department shall review the application materials within 5 days from the date of receiving them and decide whether to accept them.
2. If the application materials are incomplete, the applicant shall be informed of all the contents that need to be corrected at one time within the above five days.
3. The applicant shall, within 5 days from the date of receiving the Notice of Supplementary Materials.
4, overdue correction, as the withdrawal of the application.
5. However, after the materials are corrected, the applicant may reapply within the legal validity period.
Application completed
The Social Insurance Fund Administration shall review the materials and approve the application, and the applicant shall be reimbursed after receiving the "Social Medical Insurance Medical Expense Reimbursement Form".
Reimbursement proportion standard
Qifubiaozhun and reimbursement ratio of basic medical insurance for urban residents are determined according to the categories of insured persons.
1, students and children. In a settlement year, medical expenses below RMB 6,543,800+0,800 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 55%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
They are old people in their seventies. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
3. Other urban residents. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; 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%.
Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.
Reminder: Although medical insurance for urban residents provides basic protection for residents, the protection is relatively low, mainly to protect the medical expenses of hospitalization and outpatient service for residents with serious illness. If economic conditions permit, it is recommended to purchase commercial health insurance for full protection.