2. When reimbursing medical insurance, you need to go to the local medical insurance management center or the medical insurance settlement window of designated medical institutions for reimbursement. Procedures include: my ID card, medical insurance card, original invoice, medication list, medical records and other materials.
3. Medical insurance reimbursement is carried out in proportion, generally floating around 70%. The proportion and amount of reimbursement are related to their own examination and medication, medical level and other factors. For example, it is clear that Class A drugs can enjoy full coverage, Class C drugs need to bear all the costs, and Class B drugs will report 80% and bear 20% of the costs.
There is a deductible for reimbursement of medical insurance cards. In order to take care of the interests of the insured, Ji 'nan now implements the deductible standard, with the first-level medical institution 400 yuan, the second-level medical institution 700 yuan, and the third-level medical institution 1 1,000 yuan, 400 yuan.
1000- 10000 yuan (including 10000 yuan), 85% of the overall fund burden and 0/5% of the individual burden; 10000 yuan -90000 yuan, 88% of the overall fund burden, personal burden 12%. 90,000-200,000 yuan, 90% for the overall fund and 10% for the individual.
4. By the way, all drugs that can be reimbursed should be drugs within the scope of medical insurance. If it is drugs outside the scope of medical insurance, they are all self-funded drugs and cannot be reimbursed.
First, under normal circumstances, when you need to be hospitalized due to illness, you can go to the designated hospital with the medical insurance card and medical records, and you can use the medical insurance card for settlement. That is to say, some of them are paid by themselves at their own expense, and some medical insurance centers and hospitals reimburse and settle accounts.
Second, if you transfer from a designated hospital to a secondary or tertiary hospital, the medical insurance card will be settled, as above.
Three, critically ill, in the designated hospital emergency treatment, within 5 days to the city medical insurance center for emergency rescue disease identification, identified as emergency rescue disease, you can use the medical insurance card in the rescue hospital settlement.
Four, transferred to other places for treatment, with the consent of the hospital and medical insurance center, for referral procedures. The expenses incurred in the field shall be settled by the individual at his own expense, and after the diagnosis and treatment, the community labor security workstation shall prepare the materials for reimbursement.
Five, do special provisions of the disease (cancer, uremia, organ transplantation) that, in hospital, the same as above with medical insurance card settlement. The medical insurance card is still used when taking medicine out of the clinic, and the bills settled by individuals at their own expense will be reimbursed by the community labor security workstation this year.
Six, there is a special situation, that is, the need for cataract phacoemulsification and intraocular lens implantation, choose a capable hospital (not necessarily a hospital designated by yourself). No hospitalization, direct outpatient surgery, still using the medical insurance card, first settled at their own expense, and reimbursed by the community labor security workstation after diagnosis and treatment.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.