1, medical insurance reimbursement process for urban workers:
(1) Applicant: the participating patient himself or his spouse, parents and children. If the patient can't apply in person and has no spouse, parents or children, his brother or sister will apply on his behalf;
(2) If there are no brothers or sisters, the person in charge of the unit shall apply for it. Where an application is filed by an agent, a copy of the agent's ID card and proof of the relationship with the participating patients shall be submitted;
(3) Accepting institutions: designated medical institutions below the county level (including the county level, the same below);
(4) Application result: (1) If the identification materials of the participating patients applying for reimbursement are true and the submitted materials are complete, they will be accepted on the spot;
(5) If there is any doubt about the identification materials of the participating patients, it shall be handed over to the cooperative medical management institution for identity verification;
(6) If the submitted materials are not uniform, all materials that need to be supplemented shall be informed in writing at one time.
2, urban workers medical insurance reimbursement standards:
(1) outpatient reimbursement standard:
A deductible line: deductible line for retirees' medical insurance reimbursement 1.300 yuan, deductible line for employees 1.800 yuan.
B, capping line: 20,000 yuan;
Reimbursement ratio: on-the-job employees: 70%; Retirees under 70 years old will be reimbursed 85%, and those over 70 years old will be reimbursed 90%.
(2) hospitalization reimbursement standard:
A. deductible line: at the end of this year, the deductible line for the first hospitalization is 1.300 yuan, and for the second and subsequent hospitalization is 650 yuan;
B, capping line: 654.38+ 10,000;
Extended data:
Matters needing attention in medical insurance reimbursement for urban workers:
(1) The following expenses are not included in the reimbursement scope: registration fee, out-of-hospital consultation fee, medical record fee, home visit fee, expedited fee for examination and treatment, surcharge for roll call surgery, special medical service and health examination fee; Medical insurance such as medical consultation, medical appraisal, bed fee, ambulance fee, myopia orthopedic surgery, magnetic therapy, cosmetic surgery, infertility (pregnancy) and sexual dysfunction will not be reimbursed;
(2) Payment method of medical insurance reimbursement for urban workers: employees on the job will be paid by medical insurance to the financial account of the unit, and retirees will be paid by medical insurance to their bank cards;
(3) reimbursement methods for medical expenses in different places:
A, the basic medical insurance for urban workers, except for those who are resettled in different places, the emergency expenses incurred by other personnel in other places only during the business trip or visiting relatives can be reimbursed according to the relevant regulations of Beijing;
B, by the unit manager to the county medical insurance center for reimbursement procedures. At the same time, it is also necessary to submit the description of the unit where the first-aid expenses are located (seal of the unit).
Phoenix. Diagnosis and treatment of compound cataract can enjoy medical insurance reimbursement for urban workers in different places.
What is the standard and process of medical insurance reimbursement for urban workers?