I. Outpatient service

Medical insurance patients go to the designated medical institutions of basic medical insurance with the Handbook of Diagnosis and Treatment, and the general outpatient expenses are paid by swiping the card on the POS machine or paying in cash with the medical insurance card.

Second, the emergency department

Medical insurance patients should take the initiative to show their medical insurance identity when they see the emergency department, submit the diagnosis and treatment manual, and properly keep the medical insurance special prescription and emergency medical records.

1. Emergency observation and rescue expenses are continuous with the hospitalization process: the emergency double prescription, the copy of emergency medical records stamped with the seal of the emergency department, the invoice and copy of emergency expenses are included in the overall payment after being audited by the medical insurance department.

2. If the emergency observation and rescue expenses are not continuous with the hospitalization process, the expenses within the Qifubiaozhun shall be paid by the individual account, and those exceeding the Qifubiaozhun shall go through the reimbursement procedures at the medical insurance center.

Questions and answers on basic medical insurance policy

1. What is the minimum payment standard?

Refers to the basic medical insurance fund began to pay the standard. Medical expenses below Qifubiaozhun are paid in full by individuals, and medical expenses above Qifubiaozhun and below the maximum payment limit are calculated in proportion after deducting the above two items. The minimum qifubiaozhun for tertiary hospitals is 1 0,000 yuan for provincial and electric medical insurance,1kloc-0/15.40 yuan for the first hospitalization, 557.7 yuan for the second hospitalization and 334.62 yuan for the third hospitalization and above. If you are hospitalized in a first-class hospital and then hospitalized in a second-and third-class hospital, you must pay back the money.

Second, what is policy payment?

That is, the self-funded part stipulated by the policy: including special inspection, special treatment, self-funded proportion of Class B drugs, all self-funded drugs, over-standard bed fees and other expenses clearly stipulated by the basic medical policy.

Third, what is the proportional self-payment?

Proportional out-of-pocket payment refers to deducting "policy out-of-pocket payment" and "Qifubiaozhun" from the actual medical expenses incurred by the insured, and then calculating the individual out-of-pocket payment according to the proportion of segmented out-of-pocket payment. Provincial medical insurance (city and district medical insurance): 0-3,000 yuan: in-service 18%(26%), retirement10.8% (16.9%); 3000- 1 ten thousand yuan: 15%( 19.5%), 9%( 12.68%) retired; 1 10,000 yuan to the top line: 8%(7.8%) working and 4.8%(5.07%) retired.

4. What is the annual capping line?

The annual capping line, also known as the maximum payment limit of the basic medical co-ordination fund, refers to the maximum payment limit that enters the co-ordination fund except the "deductible line" and "policy pays". The annual capping line of provincial medical insurance is 4 1 10,000, and the annual capping line of municipal and district medical insurance is 40,000.

5. What is mutual aid for serious illness?

Mutual aid for serious illness is a kind of insurance form with the nature of mutual aid and mutual aid, which is mainly paid by the insured individuals to solve the medical expenses exceeding the maximum payment limit of the basic medical pooling fund. The annual maximum amount of provincial medical insurance mutual aid for serious illness is 1.2 million, and the annual maximum amount of municipal medical insurance mutual aid for serious illness is 1. 1 million.

6. How to calculate the medical insurance period?

The basic medical insurance is set as a "medical insurance settlement year" from April 1 day to March 3 1 day.

7. What circumstances do not belong to the scope of medical insurance payment?

Transferred to another hospital without approval; Medical expenses incurred due to criminal acts; Medical expenses incurred due to traffic accidents; Medical expenses incurred due to intentional injury by oneself or others; Medical expenses that should not be paid by the overall fund as stipulated in the basic medical insurance diagnosis and treatment items and drug list.

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