The "second reimbursement" of medical insurance in Shenyang last year was issued in March.
Source: China Business Morning News Time: 20 12-02-28
The insured person of medical insurance for urban workers is hospitalized, and pays more than 600 yuan within the scope of medical insurance, and the insured person can enjoy the "second reimbursement". Supplementary medical insurance will be implemented from 20111,and compensation will be made according to the number of medical visits of insured patients. Last year, the compensation for the "second reimbursement" of medical insurance began to be distributed in stages from March 20 12 1 day, and will be fully distributed before the end of this year.
Today, this newspaper will open a supplementary medical insurance policy consultation hotline. Please call 024-96 128 if you have any questions.
What can be reimbursed?
Exceeding 600 yuan at one's own expense can be "reimbursed twice"
The people covered by supplementary medical insurance are employees, flexible employees and retirees who have participated in the basic medical insurance for urban employees and the large medical expense subsidy insurance for urban employees in Shenyang and paid the basic medical insurance for urban employees and the large medical expense subsidy insurance premium in full.
Urban residents' medical insurance insured persons are not included in the supplementary medical insurance coverage.
The medical expenses incurred by the insured that meet the requirements of basic medical insurance, during the emergency stay in hospital for observation and transfer, during the period of invalid rescue and death, within the annual maximum payment limit of the urban workers' basic medical insurance pooling fund (the current limit in Shenyang is 6.5438+10,000), the medical expenses that meet the payment scope of the basic medical insurance pooling fund (excluding Qifubiaozhun) and exceed that of 600 yuan (excluding 600 yuan) all belong to the scope of supplementary medical care, and the compensation ratio ranges from 40% to 70%.
The part paid by individuals who enjoy the large medical expenses subsidy insurance benefits of employees after exceeding the annual maximum payment limit of the medical insurance pooling fund is not included in the scope of supplementary medical insurance reimbursement.
The treatment period of supplementary medical insurance is consistent with that of basic medical insurance. Insured employees do not enjoy basic medical insurance and large medical expenses subsidy insurance benefits, nor do they enjoy supplementary medical insurance benefits during the period of unpaid medical insurance premiums or large medical expenses subsidy insurance premiums.
How to pay the second reimbursement?
Direct compensation for medical treatment in designated hospitals this year
20 1 1 supplementary medical insurance compensation method:
The medical expenses incurred during the period of 20111October1June1February 3 1 will be paid in installments from March this year.
The specific compensation methods are as follows:
(a) retirees within the scope of the municipal co-ordination of pension insurance shall be compensated by issuing pension bank accounts;
(2) Other retirees and on-the-job employees of the unit will make compensation through their bank accounts after the unit collects relevant information (such as ID number and bank card number); Individual workers can also apply for the bid;
③ Flexible employees are compensated through Shengjing Bank's medical insurance payment account.
20 12 compensation mode of supplementary medical insurance:
From 20 12 and 1, the medical expenses incurred by the insured in the designated medical institutions that meet the supplementary medical insurance payment will be directly compensated in the designated medical institutions.
Measures for compensation for medical treatment abroad and long-term detention abroad:
For those who go abroad for medical treatment, stay in designated hospitals for a long time or go out for emergency treatment, Shenyang Medical Insurance Bureau will accept the reimbursement business, and the compensation for supplementary medical insurance will be allocated to the insured by PICC Shenyang Branch.
Compensation ratio
Out-of-pocket expenses (excluding Qifubiaozhun)
Compensation ratio
600 yuan (excluding 600 yuan) -800 yuan
40%
800 yuan (excluding 800 yuan)-1000 yuan.
50%
1000 yuan (excluding 1000 yuan)-3,000 yuan
60%
More than 3000 yuan (excluding 3000 yuan)
70%
How to bid?
According to estimates, there were179,000 people who received compensation last year, of which 92,000 people did not need to go to the medical insurance bureau, and the compensation was directly credited to the pension account. The rest include provincial pension planning and industry planning, with 87,000 people reporting.
Unit bidding operation flow:
Log on to the website of Shenyang Medical Insurance Bureau-click on the section of "Supplementary Medical Insurance Claims Payment Acceptance Platform" to view the detailed summary of unit reimbursement, confirm the reimbursement amount, print the commitment letter, fill in the relevant information as required and affix the official seal of the unit-bring my original ID card, copy and commitment letter to the supplementary medical insurance acceptance window of the Municipal Medical Insurance Bureau or branches to handle the supplementary medical insurance claims business.
Operation process of single tender:
Log on to the website of Shenyang Medical Insurance Bureau-click on the "Supplementary Medical Insurance Claims Payment Acceptance Platform" section, check the personal reimbursement detailed summary table, confirm the reimbursement amount, fill in my ICBC account, print the agreement form, and fill in the relevant information as required-bring my original ID card and copy to the supplementary medical insurance acceptance window of the Municipal Medical Insurance Bureau or branches to handle the supplementary medical insurance claims business.
Note: In principle, personal declaration is handled by me, and I confirm it. However, if the applicant is unable to handle it in person due to mobility difficulties, the agent may also handle it on his behalf with valid documents, power of attorney and other materials. This situation requires consulting the medical insurance bureau in advance.
How to inquire?
The insured can inquire about the payment of supplementary medical insurance after 20 1 1 and 20 12 in the following four ways:
Touch screen query. The insured can inquire according to the system prompts through the touch screen set in the Municipal Medical Insurance Bureau, branches, designated medical institutions and designated pharmacies.
Medical insurance website query. Insured persons log on to the website of the Municipal Medical Insurance Bureau and enter the "individual users" section for inquiry.
Self-service voice telephone inquiry. Insured persons can call the self-service voice telephone 62 167890 and make inquiries according to the voice prompts.
Medical insurance bureau business window query. The insured person can inquire in the business window of the Municipal Medical Insurance Bureau or each branch office.
For example:
The hospitalization fee is 36,000 yuan, which used to be 4,272.8 yuan, but now it is 20,065,438 yuan +0.84 yuan.
An on-the-job employee who participated in the basic medical insurance for urban workers in Shenyang incurred hospitalization expenses of 36,000 yuan (including: 8,000 yuan for Class A drugs; Class B drugs 1.6 million yuan, with the first-time self-payment ratio of 8%; In-vivo substance 12000 yuan, limited payment of 9000 yuan), minimum payment standard 1200 yuan, and self-payment ratio 14%.
The medical expenses within the scope of hospitalization fund payment include the following categories:
1 .8000 yuan for Class A drugs;
2. Deduct 8% of personal down payment from Class B drugs 16000 yuan [16000 yuan× (1-8%)] =14720 yuan;
3. The built-in material is limited to 9000 yuan.
The proportion of individual pays within the payment scope of the basic medical insurance co-ordination fund (excluding Qifubiaozhun) = (medical expenses within the payment scope of the co-ordination fund-Qifubiaozhun) × the proportion of pays 14%=(8000 yuan +65438 yuan +04720 yuan +9000 yuan -65438 yuan +0200 yuan )× 65200 yuan.