The reimbursement scope of Wuxi social security card and the reimbursement ratio of Wuxi hospital medical treatment are compiled and compiled by the editor. This article is for reference only. If there are any changes, please refer to the information released on the official website. Social security cards have a wide range of uses. Cardholders can not only use the card to seek medical treatment and conduct real-time settlement of personal medical insurance accounts, but also handle pension insurance matters; handle job registration and unemployment registration. If you want to know more about the reimbursement scope of Wuxi Social Security Card and the reimbursement ratio for medical treatment, Let’s take a look together. The reimbursement scope of Wuxi social security card and the reimbursement ratio of Wuxi hospital medical treatment are compiled and compiled. This article is for reference only. If there are any changes, please refer to the information released on the official website. Social security cards have a wide range of uses. Cardholders can not only use the card to seek medical treatment and conduct real-time settlement of personal medical insurance accounts, but also handle pension insurance affairs; handle job registration and unemployment registration procedures; apply for unemployment insurance benefits; apply for employment training; apply for labor ability appraisal and claim benefits. Work-related injury insurance benefits; handle labor and social security matters online. Wuxi social security card reimbursement scope (1) General outpatient service ◆Pay from personal account first, and can be used in designated medical institutions and designated retail pharmacies. ◆Outpatient Coordination: Patients can sign a service agreement with a community hospital recognized by themselves for treatment, and can only use it after their personal account is used up. The actual maximum annual amount that can be enjoyed is: 5,000 yuan for working personnel and 6,000 yuan for retirees. The personal burden ratios of medical expenses within the system are: 30% and 15% respectively. The first diagnosis will be made by the contracted community health service center; if you need to go to other medical institutions for treatment, you should be transferred out of the contracted community health service center according to the needs of the condition. After completing the transfer procedures, you will be transferred to the medical institution to draw your card for medical treatment. ◆Outpatient chronic diseases: 12 kinds of chronic diseases such as hypertension and coronary heart disease: you should first go to a municipal hospital for identification, choose a medical institution that you think is convenient (cannot be a community health service center), and make an appointment with the medical institution as your own hospital. After registration and agreement at the center's offices in each district, for those under the age of 70, if the individual pays more than 800 yuan, the medical insurance fund will pay 70%, and the maximum annual payment limit is 3,500 yuan; for retirees over 70 years old, the individual will pay more than 600 yuan. Yuan, the medical insurance fund pays 80%, and the maximum annual payment limit is 4,000 Yuan. (2) Ordinary hospitalization 1. Hospitalization expenses that meet the regulations: ◆Third-level hospital: discharge settlement at a third-level medical institution, medical expenses are less than 10,000 yuan (including 10,000 yuan), 84% will be paid from the employee pooling fund, and 84% will be paid by the individual The self-pay ratio is 16%; medical expenses range from 10,000 yuan to 40,000 yuan (including 40,000 yuan), the overall fund pays 88%, and the individual self-pay ratio is 12% (the individual self-pay ratio for retirees is 50% of the above standards) , the same below); ◆ Second-level and lower hospitals: For discharge settlement in first-level and second-level medical institutions, if the medical expenses of active employees are less than 10,000 yuan (including 10,000 yuan), the overall fund will pay 88%, and the individual out-of-pocket ratio is 12 %; medical expenses range from 10,000 yuan to 40,000 yuan (including 40,000 yuan), 90% is paid by the overall fund, and the individual self-payment ratio is 10% (retirement self-payment is halved); ◆Community hospital: discharged at the community health service center In settlement, if the medical expenses are less than 40,000 yuan (including 40,000 yuan), the overall fund will pay 92%, and the individual self-payment ratio will be 8% (retirement self-payment is halved); 2. Large expenses: Medical expenses fund above 40,000 yuan The payment and personal out-of-pocket ratios are unified at 92% and 8%. 3. Initial hospitalization fee: The initial hospitalization fee (threshold fee) should be paid for the first hospitalization: 950 yuan for in-service and 750 yuan for retired hospitals; 750 yuan and 600 yuan for retired hospitals; 400 yuan for first-class hospitals and community health The service center fee is uniformly 300 yuan, 50% of the above standard for the second hospitalization within the year, and 25% of the above standard for the third and subsequent hospitalizations. (3) Outpatient medical expenses for special diseases are exempt from the initial fee and enjoy hospitalization reimbursement treatment from first-level medical institutions. (4) Offices are hosted by the Wuxi Social Insurance Fund Management Center, and service windows are located in each district office. (5) Registration for medical treatment in another place. If you live for a long time or are assigned by the company to work in a different place for more than half a year, and need to seek medical treatment in another place, you can fill out the "Application Form for Medical Treatment in Another Place" (stamped with the seal of your unit and the offices of the Social Security Center). Go to the offices of the Social Security Center with your ID card and social security card to register for off-site medical treatment and receive the "Off-site Medical Treatment Certificate". You can choose three hospitals as designated hospitals in other places. Information required for reimbursement of medical treatment in another place: If you incur hospitalization expenses in another place and have filed for medical treatment in another place, please prepare the above information as soon as possible after discharge from the hospital and go to the offices of the Social Security Center for reimbursement: ◆Personal second-generation ID card, social security card ; ◆Outpatient medical records, discharge summary, valid bills and expense details; ◆Reminder medical certificate; ◆Personal bank card. (6) Employees’ medical insurance participants in Wuxi City (including Jiangyin and Yixing) who have received the “Jiangsu Province Social Security Card” through the Big City Card can apply for registration of the “Big City Card” at the social insurance agency within Wuxi City . Insured persons who have successfully registered can choose another place as a medical treatment place while maintaining the medical treatment benefits in the insured place. You can use the "Jiangsu Province Social Security Card" to swipe the card for medical treatment at designated medical institutions.

Reimbursement ratio for medical treatment in Wuxi hospitals 2. Basic medical insurance benefits for urban residents in Wuxi (1) General outpatient service ◆50% for medical treatment in community health service centers, with a limit of 800 yuan (including personal share within the scope of medical insurance); ◆In the city and in the city For medical treatment in other hospitals, the rate for those who have gone through the referral procedures is 45%, and for those who have not gone through the referral procedures, the above rate is 50%; (2) General hospitalization and special cases should be first diagnosed at the community health service center, and the hospitalization medical expenses will start from The initial fee is 200 yuan, 90% of which is paid by the medical expense fund that meets the regulations, and 10% is paid by the individual; for those transferred to other medical institutions in the urban area, the initial hospitalization fee is 300 yuan for students and children, and 600 yuan for other residents, and below the second level. For hospitalization in a medical institution, the fund pays 75% of the medical expenses that meet the regulations and the individual pays 25%. For third-level medical institutions, the fund pays 65% and the individual pays 35%. For transfers out of the urban area, the fund pays 55% and the individual pays 45%. %, if the transfer procedures are not completed as required, the fund will be paid at 50% of the above standards. ◆Maximum limit: The maximum annual cumulative medical expense of basic medical insurance for residents is 200,000 yuan. If insured residents have paid continuously for 5 years or more, the maximum annual cumulative medical expenses will be increased by 50,000 yuan; the resident medical insurance fund will no longer pay for the portion above the maximum annual cumulative medical expenses. ◆The medical expenses for outpatient treatment of special diseases are 90%, and the expenses are combined with ordinary inpatient medical expenses to calculate the annual maximum limit. (3) Wuxi Resident Basic Medical Insurance medical treatment and reimbursement process: 1. First, the insured patient takes his or her "Resident Medical Insurance Medical Record" and "Social Security Card" to the individual agreed service center for medical treatment (children under 3 years old can go directly to Medical institutions with pediatric diagnosis and treatment subjects designated by the Personal Appointment Service Center); 2. If the existing medical technology cannot provide services, the person or his family member should go to the Personal Appointment Service Center with the above card to handle the referral procedures (valid for three days) , transfer to a designated medical institution in the urban area that has the designated qualification for employee basic medical insurance for medical treatment; 3. If insured residents encounter emergencies in this city or other places (within the country), they can go to the nearest medical institution for medical treatment; 4. Emergency (need to comply with the " Jiangsu Provincial Diagnostic Standards for Emergency and Critical Illnesses") and unmarked medical expenses shall be reimbursed at the community health service center agreed upon by the insured. 3. Contents not covered by medical insurance: The social medical insurance fund will not pay for the medical expenses incurred by the insured under the following circumstances: (1) Except for emergencies, outside the designated service center agreed upon by the individual without approval and relevant procedures Expenses incurred for medical treatment; (2) Expenses incurred during the period when insured residents interrupt payment; (3) Expenses beyond the scope of the urban residents’ medical insurance drug catalog and diagnostic and treatment service items and facilities; (4) Plastic and cosmetic surgeries; (5) Childbirth expenses; (6) Going abroad or while abroad; (7) Medical expenses incurred due to crime, fights, fights, alcoholism, drug abuse, suicide, self-inflicted injuries; (8) Deliberate violations, traffic accidents, medical accidents; (9) Medical expenses incurred in other situations that violate laws and regulations; (10) Other medical expenses that do not meet the payment scope of social medical insurance. 4. Medical treatment in other places (1) Settlement of medical treatment in other places in Jiangsu Province. People from other places seek medical treatment in Wuxi: 1. Insured persons from other places first go to the insured place to apply, fill in the "Application Form for Medical Treatment in Other Places for Insured Persons", and register successfully; 2 . With the stamped and confirmed "Application Form" and ID card, go to Wuxi to apply for a local social security card, and then go to the designated hospital in Wuxi to swipe the card for settlement. (2) Wuxi insured persons seek medical treatment in other places in other areas of Jiangsu Province: 1. Insured persons who live in other places for a long time (more than 6 months) can apply for medical treatment in other places; 2. Fill out the "Application Form for Medical Treatment in Other Places for Insured Persons" and seek medical treatment in other places. Select three public medical institutions of different levels in the local area as the designated medical institutions for medical treatment; 3. If you want to choose to enjoy outpatient coordination treatment, you should choose a community health service institution as the designated first medical institution under the same conditions; 4. Registration procedures should be carried out at various offices of the Wuxi Social Security Center; 5. After successful registration, go to the medical insurance agency at the place of treatment to complete the transfer procedures; 6. Medical expenses incurred in the current year shall be settled by the end of June of the following year, and no reimbursement will be made after the expiration date. 5. Critical illness insurance benefits for urban and rural residents (1) Eligible objects: Participants in the city’s basic medical insurance for urban residents and the basic medical insurance for urban employees. (2) Scope of coverage: Critical illness medical insurance does not distinguish between types of diseases. Compliant medical expenses for inpatient and outpatient treatment of special diseases can be included in the reimbursement. (3) What are the situations in which serious illness medical insurance cannot reimburse? What is not included in the city's social medical insurance settlement system does not fall within the scope of serious illness medical insurance, including medical expenses for work-related injury and maternity insurance. (4) Reimbursement ratio and standard: The actual payment ratio of critical illness insurance is not less than 50%, as follows: ◆If the personal burden is between 10,000 yuan and 50,000 yuan (including 50,000 yuan), 50% will be subsidized; ◆Personal burden If the amount is between 50,000 yuan and 100,000 yuan (including 100,000 yuan), 60% will be subsidized; ◆If the personal burden is more than 100,000 yuan, 80% will be subsidized; ◆The minimum payment line for serious illness medical insurance is 10,000 yuan , there is no cap on the subsidy amount. ◆In addition, every two years in Xicheng, the Ministry of Human Resources and Social Security and the Ministry of Finance will adjust and introduce new minimum payment standards based on the annual per capita disposable income of urban residents in the previous year.

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