Medical reimbursement method:
1. When purchasing medicine, the cardholder will go to the designated medical insurance institution to purchase medicine, and the expenses will be paid by the personal account;
Medical insurance is divided into two accounts, personal account and medical insurance card. The money can be used to buy medicine at designated pharmacies, pay outpatient expenses and pay the part of hospitalization expenses that the individual pays. The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account;
2. Go to the outpatient clinic and keep the original diagnosis certificate, medical records, report forms and expense receipts. And go to the local social security agency for reimbursement;
When seeking medical treatment, show the medical insurance card to the designated hospital to prove the identity of the insured. At the time of checkout, the part paid by the individual is paid by medical insurance card or cash, and the part reimbursed by medical insurance is settled by medical insurance and hospital, and the individual does not need to pay first and then reimburse;
3, when in hospital, first deposit a certain amount, when discharged from hospital according to the proportion of medical insurance reimbursement for payment and settlement, refund more and make up less;
There is a deductible for hospitalization reimbursement, which means that you need to pay the deductible, and the part that exceeds the deductible can be reimbursed according to local medical insurance regulations. The reimbursement rate varies from place to place, about 75%.
To sum up, the outpatient department as a whole plays the role of big data, which improves the efficiency of fund use, effectively relieves the hospitalization problem of minor illnesses and reduces the waste of funds. Peng Jiaying, deputy director of the Medical Insurance Bureau of Kaifu District, said that in the next step, Kaifu District will expand the designated areas of employee medical insurance clinics in batches and steps, and realize the full coverage of designated medical institutions such as hospitals, community health service stations, village clinics, outpatient departments, clinics and retail pharmacies. Let the medical insurance service really reach the "home door". At the same time, Kaifu District Medical Insurance Bureau will further improve relevant policies and measures such as prescription circulation and standardized behavior, build a more convenient medical insurance service environment, and effectively release the medical insurance reform dividend.
Legal basis:
Article 30 of People's Republic of China (PRC) Social Insurance Law
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.