The second reimbursement of medical insurance means that after the reimbursement of basic medical insurance, retirees, military disability subsidies and other funds will report part of the amount that needs to be paid by individuals according to the corresponding proportion. In fact, it is the reimbursement of supplementary medical insurance. That is to say, the hospitalization expenses that have been settled in the hospital within one year (including family beds and medical treatment outside the city), the accumulated part of individual out-of-pocket expenses MINUS the part of class C expenses 1 10,000 yuan or more, can enjoy the second subsidy from the medical insurance fund.
Secondary reimbursement process of medical insurance:
First, outpatient and emergency expenses reimbursement
The deductible line for large medical mutual assistance (outpatient service and emergency treatment) is 2,000 yuan for employees and retirees 1300 yuan. The accumulated outpatient and emergency expenses of employees within one year are less than 2,000 yuan, and the retirees 1.300 yuan shall be paid by the insured from their personal accounts. If the amount reaches above the deductible within a natural year, a large medical mutual assistance system can be applied.
Second, reimbursement of hospitalization expenses.
According to the regulations, when the current basic medical insurance is used to pay the hospitalization expenses for the first time in a year, the deductible amount of both working and retired people is 1300 yuan. The medical expenses for the second and subsequent hospitalization are determined according to the deductible line of 50%, which is 650 yuan. The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan. The individual contribution ratio of retirees is 60% of the individual contribution ratio of employees, but the part below the minimum deductible is the same, and all of them are paid by individuals. The standard of hospitalization reimbursement is related to the level of the medical institution where the insured person is located.
Note: Outpatient service and hospitalization are two deductible lines.
3. How much does the hospitalization cost exceed the maximum payment limit?
If the hospitalization expenses of the insured exceed the maximum payment limit, the excess expenses will be reimbursed according to the relevant standards of large-scale medical mutual assistance, that is, 70% will be paid by large-scale medical mutual assistance funds and 30% by individuals. Within one year, the accumulated maximum payment amount of large-scale medical mutual assistance is 654.38+10,000 yuan.
Information required for the second reimbursement of medical insurance:
When receiving the second subsidy, please hold the original and photocopy of the second-generation resident ID card of the person who enjoys the second subsidy and his local bank card or passbook (except the account number of the rural commercial bank); If you don't handle it yourself, you need the original and copy of the agent's second-generation resident ID card.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.