2. After the insured is hospitalized, the deductible line of the overall fund is divided into three grades: tertiary hospital 1000 yuan, secondary hospital 600 yuan, and primary hospital 400 yuan. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.
3, the insured due to illness need referral (hospitalization), shall be approved by the designated medical institutions (three or more) deputy chief physician or chief physician diagnosis put forward referral (hospitalization) opinions, by the unit to fill in the application form, after the designated medical institutions medical insurance management department audit report to the municipal (District) social security institutions for approval for referral (hospitalization) procedures.
4. When the designated medical institutions are discharged from the hospital, the reimbursement amount and the amount payable by individuals shall be calculated by the designated medical institutions, and the reimbursement amount shall be settled by the designated medical institutions and urban social insurance agencies, and the amount payable by individuals shall be settled by the designated medical institutions and the insured.
5. When visiting a designated hospital, show the medical insurance card to prove the identity and registration of the insured. Individuals do not need to pay first and then reimburse, and the part of medical insurance reimbursement can be directly settled by medical insurance and hospitals. Only when the account is settled, the self-funded part will be paid by the balance of the medical insurance card or cash.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Article 4 Employers and individuals who pay social insurance premiums according to law in People's Republic of China (PRC) have the right to inquire about payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services.
Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.
Fifth people's governments at or above the county level shall incorporate social insurance into the national economic and social development plan.
The state raises social insurance funds through multiple channels. People's governments at or above the county level shall give necessary financial support to social insurance.
The state supports social insurance through preferential tax policies.