The waiting period for social medical insurance is generally six months, and in some areas it is three months. I haven't heard of anything shorter. The general standard reimbursement rate is 80%, but due to self-funded projects, the average reimbursement rate is about 65%.
There are three kinds of medical insurance in social security: basic medical insurance for urban workers; Basic medical insurance for urban residents; New rural cooperative medical system
1, after getting the basic medical insurance for urban workers. Generally, the money in the card is used to see a doctor in an outpatient clinic or buy medicine in a pharmacy, so it is not enough to pay cash by yourself. About 80% can be reimbursed for hospitalization (see several hospitals). However, outpatient clinics in several big cities in Shanghai and Beijing can be reimbursed if they exceed the prescribed amount. (This is a regional difference)
2. Basic medical insurance for urban residents. Generally, the payment is made this year, and it will be invalid in that year. You can only be reimbursed if you are hospitalized next year. In the community hospital (level 1) outpatient service can be preferential, and the second-level and above hospitals can not be reimbursed. For example, if you pay it this year, you can use it next year, and you can still use it next year. If you forget to pay in one year, you won't be able to enjoy it in the second year.
3. New rural cooperative medical system. Same as above; It is also the second year that hospitalization can be reimbursed, and medicine can be obtained at a discount in the village clinic. The new rural cooperative medical system also has preferential policies; Even after hospitalization reimbursement, the rest (with bills and hospitalization summary) can be reimbursed when they return to villages and towns.
The above three kinds of social medical insurance pay less, which is the welfare treatment given by the state to the people. General hospitalization can be reimbursed, but outpatient service cannot be reimbursed. However, if you have a serious illness, you can apply for a "certificate of serious illness clinic". For serious diseases that meet the requirements, they can also be reimbursed according to the regulations after obtaining the application and obtaining the certificate.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
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.
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(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.