Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established to provide basic medical needs for workers within the scope of coverage when they fall ill.

All basic medical insurance premiums paid by individual employees are included in their personal accounts; basic medical insurance premiums paid by employers are divided into two parts, one part is transferred to the personal account, and the other part is used to establish a pooling fund.

In this article, I would like to introduce you to the relevant knowledge about the reimbursement of Jiaxing Medical Insurance.

It mainly includes information about Jiaxing Medical Insurance reimbursement process, Jiaxing Medical Insurance reimbursement ratio, and Jiaxing Medical Insurance reimbursement policy.

1. Jiaxing medical insurance reimbursement process and required materials Reimbursement of hospitalization medical expenses: 1. Original invoice for hospitalization medical expenses; 2. Summary list of medical expenses; 3. Discharge summary; 4. Copy of "Combined Medical Card".

Reimbursement of outpatient medical expenses: The original invoice must be confirmed and stamped by the hospital where you visited.

Reimbursement process for hospitalization medical expense reimbursement: 1. Insured persons who are hospitalized in designated hospitals within the city and meet the reimbursement regulations will be reported in real time by swiping their card; 2. Those who do not meet the conditions for real-time settlement (such as trauma, etc.) and those who are hospitalized in designated hospitals outside the city

, based on the above materials, submit an application to the town (street) joint medical office. After preliminary review by the town (street) joint medical office, it will be submitted to the municipal joint medical office once a week. The municipal joint medical office will wait 10 working days after receiving the reimbursement materials.

Complete the audit and report work within 12 days.

Note: If no compensation is applied for within 3 months after the end of the year, it will be automatically abandoned.

Outpatient medical expense reimbursement: real-time settlement by swiping your card.

Outpatient expenses that are not reported in real time due to hospital reasons shall be confirmed and stamped by the hospital where the patient was treated, and the original invoice shall be used to regularly apply for compensation to the town (street) joint medical office.

Note: Outpatient expenses that are not swiped in real time without special reasons will not be reimbursed.

2. Jiaxing Medical Insurance Reimbursement Ratio and Related Policies Reimbursement Ratio Employees participating in the Employee Basic Medical Insurance Accounting 1: Reimbursement of hospitalization medical expenses: Minimum payment standard: 300 yuan for first-level and lower medical institutions (community health service institutions), 300 yuan for second-level (county-level)

) medical institutions are 500 yuan, and third-level (municipal) medical institutions are 800 yuan.

Reimbursement ratio: The portion above the minimum payment standard and below the maximum payment limit will be paid from the overall fund in the following proportions: 90% for first-level and lower medical institutions (community health service institutions); 85% for second-level (county-level) medical institutions

;Tertiary (municipal) medical institutions are 80%.

Reimbursement of outpatient medical expenses: Minimum payment standard: The minimum outpatient payment standard is 500 yuan for active employees and 300 yuan for retirees; Reimbursement ratio: 1. Insured persons have medical expenses that meet the requirements of the requirements of the community health service center (station) that implements the national essential drug system.

For outpatient (emergency) medical expenses within the payment scope specified by the basic medical insurance, the portion above the outpatient minimum payment standard and below the maximum outpatient payment limit will be paid by the overall fund at a rate of 70%; 2. In other designated medical institutions (retail pharmacies)

For outpatient (emergency) outpatient (drug purchase) expenses incurred that meet the payment scope stipulated by basic medical insurance, the portion above the outpatient minimum payment standard and below the maximum outpatient payment limit will be paid by the unified fund at a rate of 40%.

Participating in the Employee Basic Medical Insurance Accounting II: Reimbursement of hospitalization medical expenses: Minimum payment standard: 300 yuan for first-level and lower medical institutions (community health service institutions), 500 yuan for second-level (county-level) medical institutions, and 500 yuan for third-level (municipal-level) medical institutions

800 yuan for medical institutions.

Reimbursement ratio: The portion above the minimum payment standard and below the maximum payment limit will be paid from the overall fund in the following proportions: 90% for first-level and lower medical institutions (community health service institutions); 85% for second-level (county-level) medical institutions

;Tertiary (municipal) medical institutions are 80%.

Reimbursement of outpatient medical expenses: Minimum payment standard: 500 yuan for active employees and 300 yuan for retirees; Reimbursement ratio: 1. Insured persons who meet the basic medical insurance regulations at community health service centers (stations) that implement the national essential drug system

Outpatient (emergency) medical expenses within the scope of payment are first paid from the personal account transferred in the current year. If the personal account transferred in the current year is insufficient to pay, the portion above the outpatient minimum payment standard and below the maximum outpatient payment limit will be paid from the overall fund at 80%.

Proportional payment; 2. Outpatient (emergency) clinic (drug purchase) expenses incurred in other designated medical institutions (retail pharmacies) that comply with the payment scope of basic medical insurance regulations will be paid first from the personal account transferred in the current year, and then transferred to the personal account in the current year.

Insufficient payment, from the minimum outpatient payment standard to the maximum outpatient payment limit, will be paid by the overall fund at a rate of 50%.