Social medical insurance card, referred to as medical insurance card or medical insurance card, is a special card for personal account of medical insurance. With the personal identity card as the identification code, the detailed information such as personal identity card number, name, gender, account capital expenditure and consumption are stored and recorded.
The medical insurance card is undertaken by the local designated agent bank, which is a multi-functional debit card of the bank. After the insured unit pays the fee, the local medical insurance department will entrust the bank to transfer the personal account payment to the personal medical insurance card of the insured employee at the end of the month.
Medical insurance reimbursement scope:
1, outpatient medical treatment cannot be reimbursed, and it can only be reimbursed if it is hospitalized and reported to the medical insurance bureau for the record;
2. Dental cases are generally not covered by medical insurance;
3. You can pay the outpatient fee with your personal medical insurance card first, so you can pay for it yourself.
The difference between medical insurance drugs and non-medical insurance drugs, reimbursement deductible line is also different according to hospital level. Generally, Class A drugs can enjoy full reimbursement, Class C drugs need to pay all the expenses, and Class B drugs need to pay 80% and 20%.
Reimbursement scope of rural medical insurance:
1, outpatient compensation:
(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.
(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.
(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.
(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.
(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.
(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.
2, hospitalization compensation
(1) Reimbursement scope:
A. Drug expenses: auxiliary examination: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT and nuclear magnetic resonance are limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).
B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
(2) Reimbursement ratio: town hospitals reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
3. Compensation for serious illness
(1) town risk fund compensation: where the medical expenses of inpatients participating in rural cooperative medical insurance exceed 5,000 yuan at one time or throughout the year, they should be compensated by stages, that is, 5001-kloc-0/0000 yuan will be compensated by 65%,10001-.
(2) The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system inpatient and uremia clinic is1.65,438+0.000 yuan.
The scope of reimbursement of medical insurance for urban residents:
1, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.). );
2, organs, institutions, social organizations, private non enterprise units and their employees, to participate in the basic medical insurance;
3. Some towns and villages stipulate that township enterprises and their employees, owners of urban individual economic organizations and their employees should be gradually incorporated into the basic medical insurance coverage (the last one depends on different local policies), so that they can enjoy medical reimbursement.
Urban medical reimbursement mainly refers to medical treatment, medication, hospitalization, surgery, etc. And medical expenses can be reimbursed by medical insurance card in accordance with relevant regulations. Urban medical insurance is more specific, and the project scale and coverage are large.