(a) the use of medical insurance card to outpatient treatment, real-time settlement, no reimbursement.
(two) no medical insurance card to the outpatient clinic.
1. Reimbursement scope: general outpatient and emergency expenses incurred by the insured in designated hospitals or specialized hospitals, traditional Chinese medicine hospitals and tertiary hospitals selected by individuals.
2. Outpatient deductible line: the total emergency expenses of general outpatient service exceed 1.800 yuan in a natural year.
3. Reimbursement ratio: 70% for the hospital, 90% for the community, and the top line: 20,000 yuan.
4. Submission time: every month 1- 10, the expenses of the current month shall be submitted the next month, and the expenses of the current year shall be submitted before 1 the following year.
5. Handling process: If the accumulated Qifubiaozhun exceeds the Qifubiaozhun in a natural year, the unit manager will input all the documents into the enterprise software and report the generated electronic information and statements to the medical insurance center, which will complete the review, settlement and payment of reimbursement expenses within 30 working days.
Second, hospitalization.
1. Reimbursement scope: hospitalization expenses incurred by the insured in designated hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by the individual.
2. Inpatient deductible line: The standard of the first hospitalization deductible line in a natural year is 1.300 yuan, with 650 yuan as the unit each time.
3. Reimbursement ratio: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total reimbursement of 300,000 yuan for hospitalization.
4. Handling process: If the unit pays the full fee, the individual can handle the hospitalization formalities only by paying part of the hospitalization advance payment, and the medical expenses incurred should be in line with the scope of medical insurance. When leaving the hospital, the hospital and the individual will settle the expenses themselves, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center.