The medical insurance reimbursement process for medical treatment in Beijing is as follows: 1. Filing for medical treatment in other places: First, you need to go through the registration procedures for medical treatment in other places, which can be done online or offline.
Online processing can be done through the National Medical Insurance Service Platform APP, the National Off-site Medical Registration Mini Program and other channels; offline processing requires going to the local medical insurance agency or social security center.
2. Registration and diagnosis and treatment: During registration and diagnosis and treatment, you need to inform the doctor that you have completed the registration procedures for medical treatment in another place, and present your medical insurance card or electronic medical insurance voucher.
3. Fee settlement: When settling fees, you need to present your medical insurance card or medical insurance electronic voucher, and settle in accordance with medical insurance policies.
Beijing’s medical insurance policy mainly includes the following aspects: 1. Medical insurance coverage: all urban employers within the administrative region of Beijing, including enterprises, government agencies, institutions, social groups, private non-enterprise units and their employees and retirees.
Everyone should participate in basic medical insurance.
2. Medical insurance payment standards: Basic medical insurance premiums are borne by both the employer and individual employees, paid simultaneously, and coordinated by the city.
The basic medical insurance fund implements the principle of combining social pooling and personal accounts.
The protection level of basic medical insurance should be compatible with the development level of social productivity in this city and the affordability of finance, employers and individuals.
3. Scope of medical insurance reimbursement: When insured persons go to communities and other designated primary medical insurance designated medical institutions for medical treatment, drugs used in large hospitals can be used and reimbursed in the community.
At the same time, medical insurance also stipulates the scope and proportion of reimbursement, and the reimbursement proportions of medical expenses are different in different situations.
4. Medical insurance supervision: The municipal labor and social security administrative department is in charge of the city's medical insurance work, organizes the implementation of the medical insurance system, and is responsible for the management, supervision and inspection of medical insurance work.
District and county labor and security administrative departments are responsible for the management, supervision and inspection of medical insurance within their respective administrative regions.
Social insurance agencies established by municipal and district and county labor and security administrative departments specifically handle medical insurance work.
The coverage rate and reimbursement ratio of Beijing’s medical insurance are two very important aspects of the medical insurance policy.
In terms of coverage, Beijing’s medical insurance policy covers employees and retirees of all urban employers, achieving extensive social security.
In terms of reimbursement ratios, Beijing’s medical insurance policy formulates different reimbursement ratios based on different medical conditions and expenses.
For example, the reimbursement ratio for hospital outpatient services for active employees reaches more than 70%, for retirees more than 85%, and for community health institutions, the reimbursement ratio is 90%.
The hospitalization reimbursement ratio for active employees is more than 85%, and the hospitalization reimbursement ratio for retirees is more than 90%, up to 99.1%.
At the same time, medical insurance also stipulates a maximum payment limit. Medical expenses exceeding the maximum payment limit will no longer be paid by the basic medical insurance fund.
To sum up: different groups of people and different types of medical expenses may have different reimbursement ratios and limits, and specific policies may be adjusted based on time and specific circumstances.