Take a city as an example.
1. General outpatient service: the annual settlement unit is 40% of the outpatient medical expenses below 300 yuan, that is, the maximum 120 yuan/year. After one-time settlement, the expenses above 300 yuan need to be paid by individuals.
2. Serious illness outpatient service: hemophilia, aplastic anemia, systemic lupus erythematosus and other diseases, the fund has no minimum payment limit, and the medical insurance fund pays 75%.
3. Hospitalization: different hospitalization qifubiaozhun and fund payment ratio are set according to the level of medical institutions. Take a tertiary hospital as an example. The standard is above 500 yuan, and the fund payment ratio is 80%.
What materials do I need to bring for reimbursement?
1, original outpatient invoice; If there are no specific diagnosis and treatment items and drug items on the outpatient invoice (items must include unit price and quantity), or if the items are incomplete, a complete list of outpatient medical expenses should be provided;
2. Original hospitalization invoice; Summary of hospitalization medical expenses; Discharge summary or record (stage summary is provided in the middle of checkout, and death summary or record is provided by the deceased);
3. The insured;
4. Local savings card or debit card with UnionPay logo of the insured or agent (except CITIC, Minsheng, China Merchants Bank and credit card);
5. If the non-insured person comes to handle it himself, provide the original and photocopy of the agent's ID card;
6. If the name of the invoice is mother's or father's name followed by "son" or "daughter", provide the original and a copy of the birth certificate (the original birth certificate should be filled with the name of the newborn before copying);
7. If the name of the invoice is neither the name of the insured newborn nor the name of the mother or father followed by "son" or "daughter", it must be changed in the hospital, and the official seal of the hospital shall be affixed to the changed place; The names of vouchers such as expense list and discharge summary should be changed at the same time;
8. When the mother is hospitalized during childbirth, if the hospital issues separate invoices and summary tables for the newborn, the related expenses of the newborn can be reimbursed, but the mother's discharge summary (or record) must be provided;
9. If the medical expenses span two social/medical insurance years, the expense list shall be separated by year. For example, he was admitted to the hospital on June 20 12, 15, and was discharged on July 10. In the case that the insured pays in both medical insurance years, the summary list must be divided into two parts by year: 1 June 5 to June 30 and1July to July.
Proportion of medical insurance reimbursement for students and children
In a settlement year, medical expenses less than RMB 6,543,800,000+800,000 which are within the scope of reimbursement occur:
1. The threshold of tertiary hospitals is 500 yuan, and the reimbursement rate is 55%;
2. The Qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%;
3. There is no Qifubiaozhun in the first-level hospital, and the reimbursement rate is 65%.
Proportion of medical insurance reimbursement for the elderly (over 70 years old)
In a settlement year, medical expenses below 654.38+10,000 yuan that meet the scope of reimbursement occur:
1. The threshold of tertiary hospital is 500 yuan, and the reimbursement rate is 50%;
2. The Qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%;
3. There is no Qifubiaozhun in the first-level hospital, and the reimbursement rate is 65%.
Orientation and Process of Children's Medical Insurance in Guangxi
1. Required materials: the original household registration book+a copy of the first page of the household registration book and the baby's own page, and the original and copy of the agent's ID card.
2. Handling place: the street office where the household registration is located.
3. Handling fee: RMB 100 per person per year, with 60 yuan paid by individuals and 40 yuan subsidized by the government; Students and children with severe disabilities, subsistence allowances and special family difficulties do not pay fees, and the government grants 100 yuan.
4. Enjoy treatment: hospitalization 50%, emergency 50% (it seems that the baby medical insurance card can only be hospitalized).
Note: Do it after reimbursement. After registration, you can pick up the list according to the notice of the street office, which usually takes 45 working days.
Legal basis:
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.