1。 Proportion of hospitalization reimbursement

The reimbursement rates of tertiary, secondary and primary hospitals are 70%, 80% and 85% respectively, and the minimum payment standard is 100 yuan in 300 yuan and 200 yuan respectively. Zhaofa. Com reminds that if the insured minor residents are transferred to other places for treatment, the reimbursement rate of medical insurance is 70%, and the threshold fee is 1500 yuan.

2。 Outpatient reimbursement

In the medical insurance settlement year, the general outpatient medical expenses incurred by the insured minor residents in designated community health service centers (stations), township hospitals or school hospitals (school outpatient departments and school clinics) and other grassroots designated medical institutions shall be borne by the individual first, and the medical expenses that meet the Qifubiaozhun above the basic medical insurance payment scope shall be paid by the overall planning fund for 50%, and the annual overall planning fund shall pay the highest 300 yuan.

What are the conditions for medical insurance reimbursement?

According to the basic requirements of the payment of basic medical insurance benefits in China, the insured person who goes to the medical insurance institution to reimburse the medical expenses incurred by himself for medical treatment generally meets the following conditions:

(1) The insured must go to the designated medical institution of basic medical insurance or to the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital.

(2) The medical expenses incurred by the insured in the process of medical treatment must conform to the basic medical insurance drug list, diagnosis and treatment items, the standard scope of medical service facilities and payment standards, and be paid by the basic medical insurance fund according to regulations.

(III) Among the medical expenses that the insured meets the scope of payment of basic medical insurance, the part that is higher than the Qifubiaozhun of the social medical co-ordination fund and lower than the maximum payment limit shall be paid by the social medical co-ordination fund in a unified proportion.

I. Precautions for Newborn Insurance

Newborns should pay attention to the following items:

1。 Only newborns with local household registration.

2。 If you apply for insurance within the household registration 1 month and can provide a copy of your birth certificate and your mother's ID card, you can pay the fee from the month of birth and enjoy medical insurance benefits from the day of birth.

3。 If you go through the insurance formalities within 1 month after entering the household and fail to provide a copy of your birth certificate and your mother's ID card, you will pay the fee from the month of application and enjoy medical insurance benefits from the month after payment.

4。 /kloc-those who go through the insurance formalities after living for 0/month shall pay the fees from the month of application and enjoy medical insurance benefits from the month after payment.

Second, how to activate the children's medical insurance card

The activation method of children's medical insurance card is as follows:

1。 The insured person needs to bring his social security card and the original identity certificate to the corresponding bank outlet to activate the social security card, and the medical insurance account will return to normal after activation.

2。 Use social security card to directly enable social security function in designated medical insurance hospitals. When the insured person uses the social security card for the first time in a designated medical institution, he can directly activate the social security function by simply registering for outpatient service or hospitalization.

3。 When the insured uses the social security card for the first time in the designated medical insurance pharmacy, he inserts the original medical insurance card, and then inserts the social security card as required to activate the social security card.

Three, medical insurance settlement procedures

(1) Settlement procedures for inpatient and outpatient treatment of special diseases

Designated medical institutions shall submit the expense list, hospitalization list and related materials of discharged patients last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination. The medical insurance agency pre-allocated the hospitalization and outpatient expenses for special diseases last month.

Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.

(2) Emergency settlement procedures

The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall handle the reimbursement procedures according to the provisions with the emergency hospitalization medical records, inspection, laboratory test sheets, invoices and detailed list of medical expenses.

Fourth, what is the process of changing special diseases?

1, local filing change process

If the local special disease record has not expired and the insured needs to change the designated medical institutions for special diseases due to illness, he should go through the cancellation procedures at the designated hospitals for special diseases with the social security card.

Before going through the cancellation procedures, the expenses for special diseases shall be settled in the original designated hospital, and the Beijing Medical Insurance Special Diseases Record Cancellation Form shall be issued by the original designated hospital for special diseases. The next day, the social security card and the Beijing Medical Insurance Special Diseases Record Cancellation Form shall be used to go through the re-registration procedures at the newly selected local designated hospital for special diseases.

2, off-site filing change process

If the record of special diseases in other places has not expired, and the insured person needs to change the designated medical institutions for special diseases due to illness, he should go through the cancellation procedures at the medical insurance center of the insured place (county) with the social security card and the explanation of the change of special hospitals issued by the unit.

I hope the above content can help you. If in doubt, please consult a professional lawyer.

legal ground

Article 29 of People's Republic of China (PRC) Social Insurance Law

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.

Article 25

The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.