First, the accumulated basic medical insurance expenses for the whole year are less than 65,438+10,000, and the proportions of medical insurance funds are as follows:
1. 92% of employees and 93% of retired employees can be reimbursed by community and first-class hospital funds. 6%;
2. The employees in the secondary hospital fund can be reimbursed 89%, and the retired employees can be reimbursed 9 1. 2%;
3. In-service employees of tertiary hospital funds can be reimbursed 86%, and retired employees can be reimbursed 88%. 8%;
4, enjoy the treatment of the disabled, the overall fund payment ratio increased by 2%;
Two, the annual cumulative basic medical insurance costs10-200 thousand, medical insurance fund to pay 96%;
Three, the annual cumulative basic medical insurance costs in 200-240 thousand, the medical insurance fund to pay 98%;
Four, the use of class B drugs or treatment projects belonging to medical insurance coverage, the individual pays 10% first, and the balance is paid by the medical insurance fund according to the above proportion.
Medical insurance reimbursement process:
1, medical insurance, whether urban workers' medical care or urban residents' medical care, first needs to be hospitalized in local designated medical institutions approved by local medical insurance institutions.
2. If you need to transfer to other medical institutions for treatment, you need to issue a referral certificate to the local community hospital or community health service center or designated medical institutions.
3. If you are hospitalized in a local designated medical institution, the hospital will automatically deduct the medical insurance reimbursement for you when you check out.
4. Those who have been treated by local medical insurance but have not been hospitalized, or who have received radiotherapy or chemotherapy but have not been reimbursed in the hospital, can bring the official invoice, medical diagnosis, medication list, social security card or medical card issued by the hospital to the medical insurance window of the local administrative service center for reimbursement.
5. Those who have been treated in other medical institutions and have a referral certificate must submit all the treatment invoices, hospital diagnosis certificate, hospitalization certificate, ID card, social security card, medication list and medical records to the medical insurance window where the household registration (medical insurance) is located before 65438+February 3 1 every year.
6. If you don't have a referral certificate or go to a different place to see a doctor directly (sometimes it's urgent or too far to issue a referral certificate in time), you need to issue a residence certificate in the community where you live, such as renting here or living with your children. When submitting the reimbursement, bring all the materials in step 5, plus proof of residence.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
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.