1~ ~ The medical insurance for urban workers handled by the unit can enjoy hospitalization (medical insurance reimbursement) as long as there is a card in the next month and there is no arrears; Urban workers (flexible employees) personal medical insurance, after six months of payment, can enjoy hospitalization (medical insurance reimbursement), without arrears. Residents' medical insurance, 165438+ 10 to the end of the year, and they can enjoy hospitalization (medical insurance reimbursement) the following year 1 month.
Reimbursement ratio? For medical insurance hospitalization, except for the self-paid part and self-paid 10%, the part exceeding the hospitalization medical insurance deductible line enjoys the proportion of overall payment. Different levels of hospitals have different threshold fees and enjoy different proportions of overall payment. The proportion of medical insurance for employees is over 80% (84%/86%/89% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan).
2~~~ Medical insurance outpatient reimbursement-
Medical insurance for residents:
In an insurance year, if the general outpatient expenses of insured residents in designated outpatient medical institutions are within 100 yuan (inclusive), the residents' medical insurance fund will pay 30% and individuals will pay 70%; Personal consumption exceeds 100 yuan.
Medical insurance for urban workers:
The personal account on the medical insurance card of the insured person insured by the unit is not paid by himself; Since last year, the medical insurance card for flexible employees has also had a personal account, which is 15 yuan (Wuhan) per month, which can be used to pay outpatient expenses, which is equivalent to outpatient reimbursement (unless the insured belongs to civil servants or the unit has another reimbursement policy).
3 ~ ~ ~ ~ Medical treatment in different places without going through the examination and approval procedures first can only be reimbursed in an emergency.
Application in Different Places-First, apply for medical treatment in different places in the medical insurance center of the insured place, get three approval forms, find the medical insurance offices of three (or two) designated hospitals with different levels of medical insurance in different places, and then send them to the medical insurance center of the insured place for filing, so that you can be hospitalized in different places, pay in advance in cash, and send them back (or send them back) to the medical insurance center of the insured place for reimbursement with the settlement bill, discharge summary and daily list.
If it is an emergency, within 5 working days after hospitalization, the agent of your insured unit (or the insured person) will write a written report on medical treatment (specifying the time, place, illness and treatment in detail), which will be stamped by the unit (the social security department of the jurisdiction will stamp the relocated person), and attached with outpatient emergency medical records, relevant inspection reports, 120 emergency invoices and other materials to the emergency rescue declaration window of the medical insurance center in the insured area;
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.