The proportion of medical insurance reimbursement has always been a topic of concern to everyone. Overreporting and underreporting are directly related to everyone's welfare, but do you really understand these reimbursement rates? Do you really understand the reimbursement process? Let's take a look at the reimbursement rate of medical insurance first, so that we can better understand our welfare. The reimbursement rate of the threshold fee above 3,000 yuan is 88%, that of 3,000-5,000 yuan is 90%, that of 5,000-10000 yuan is 92%, and that of10000 yuan is 95%, of which 80% is Class B drugs, and 70% is expensive drugs and special examination and treatment. Medical insurance reimbursement process in different places: medical treatment in different places needs to be approved by relevant departments first. 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. The time limit for approval in different places is generally one year, that is, from the date of handling to the date of the second year. You can't change it within a year. If the approval period has passed, the parties who are still in different places need to go to the relevant departments for re-approval. For the parties in different places, it is essential to choose a different hospital. The regulations on how many hospitals patients can choose in different regions are different. Generally, you can choose two or three. For the medical expenses incurred by the parties in designated hospitals in different places, the relevant reimbursement documents will be mailed back to the original city for reimbursement, or family members can be asked to help reimburse in the original city. Issues such as reimbursement standards will still be in accordance with the regulations of the city, and relevant funds can be collected by family members or related accounts can be set up. Proportion of reimbursement for medical insurance in different places: the medical expenses of medical insurance personal account can be transferred to Zigui Medical Insurance Bureau regularly, and hospitals in other provinces are designated hospitals for local medical insurance. Procedures for reimbursement of medical insurance in different places: for medical treatment in different places, you need to go to the outpatient department and hospital to issue receipts, lists, prescriptions, details, medical insurance manuals and case diagnosis certificates of relevant expenses, and at the same time, you need to issue the registration certificate of the hospital, which is convenient for employers, social security offices and district and county medical insurance centers to make statistical summary, audit and settlement.
Legal objectivity:
Social insurance law
Article 28
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.
Social insurance law
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.