When looking for a job, most people will ask whether the company has paid five insurances and one gold, that is, social security, but in fact, we are most concerned about only three pieces of social security, one is medical insurance, the other is endowment insurance and the other is housing provident fund, because these three pieces are actually three needs that no one can avoid in our lives.

Medical insurance-to ensure that we have enough money to receive treatment when we are sick;

Endowment insurance-to ensure our happiness in old age;

Housing accumulation fund-to ensure that we can have our own place in the city where we live.

Let's talk about medical insurance reimbursement today!

Although the reimbursement system of medical insurance is the same in a big way, it is different in the initial compensation, so please consult the local social security agency for the relevant reimbursement amount. This paper takes Beijing medical insurance reimbursement as an example.

First, the scope of medical insurance payment

1, personal account payable range.

(a) outpatient and emergency medical expenses;

(2) the cost of purchasing drugs in designated retail pharmacies;

③ Medical expenses below the Qifubiaozhun of the basic medical insurance pooling fund;

(4) medical expenses that exceed the qifubiaozhun of the basic medical insurance pooling fund and should be borne by individuals in proportion.

Note: If the personal account is insufficient to cover the medical expenses incurred by the treatment, the expenses shall be borne by me.

2, the basic medical insurance fund can pay the cost

① Hospitalization medical expenses;

(2) medical expenses within 7 days before emergency observation and hospitalization;

③ Outpatient medical expenses for taking anti-rejection drugs after radiotherapy and chemotherapy, renal dialysis and renal transplantation for malignant tumors.

Note: The basic medical insurance pooling fund cannot be used to pay for general outpatient expenses and self-funded items.

Some friends may be confused here-can outpatient expenses be reimbursed? Yes, outpatient service can be reimbursed, but outpatient expenses are not reimbursed from the basic medical insurance pooling fund. Second, outpatient service is paid from a large fund.

Two, the basic medical insurance fund will not be paid.

(a) the cost of medical treatment in a medical institution other than my designated medical institution, except for emergency;

(2) the cost of purchasing drugs in non-designated retail pharmacies;

(three) the cost of injury caused by traffic accidents, medical accidents or other accidents;

(four) the cost of injury caused by drug abuse, fighting or other illegal acts;

(5) Treatment expenses for suicide, self-mutilation, alcoholism and other reasons;

⑥ Expenses for treatment abroad or in Hongkong, Macao Special Administrative Region and Taiwan Province Province;

All landowners according to the provisions of the state and the province should be paid by individuals, mainly drugs and medical devices outside the social security directory.

Third, the proportion of medical insurance reimbursement

1, outpatient reimbursement ratio

Remarks: within a medical insurance year (65438+ 10 month 1 to 65438+February 3 1), the accumulated amount of 1800 is deductible.

2. Proportion of hospitalization reimbursement

Remarks:

1, Qifubiaozhun: within a medical insurance year, the Qifubiaozhun is 1300 yuan for the first hospitalization, and 650 yuan for the second and later;

2. The medical service fee is not included in the deductible line and the capping line;

2. Reimbursement proportion: the method of subsection calculation and cumulative payment is adopted, and the payment proportion is calculated separately according to the hospital level;

Fourth, the reimbursement process

Medical insurance reimbursement is generally settled in real time, but the following eight situations need manual settlement:

(1) Medical expenses during the new enrollment period without social security card;

(2) expenses incurred in emergency treatment of designated medical institutions without cards;

(3) Loss reporting of social security card, and expenses incurred during the period of making up (replacing) the card after medical release;

(4) Manual reimbursement of expenses incurred during medical treatment;

(5) The expenses incurred in seeking medical treatment during the arrears period;

⑥ The cost of family planning operation for those who did not participate in maternity insurance;

All landowners in accordance with the provisions of the medical insurance in other places of medical expenses;

The cost of drugs purchased in this city that meet the requirements of medical insurance.

1. Materials required for reimbursement

(1) outpatient (emergency) consultation: receipt, drug prescription, examination and treatment fee details;

② Hospitalization expenses: receipts, expense lists, statements and medical diagnosis certificates;

(3) Various inspection reports must be accompanied by detailed information.

2, outpatient reimbursement process

Third, the hospitalization reimbursement process

Verb (abbreviation of verb) solves common medical insurance problems.

1, which expenses cannot be reimbursed by medical insurance?

Registration fee, out-of-hospital consultation fee, medical record fee, house call fee, urgent fee for examination and treatment, surcharge for name-calling operation, special medical service, health examination fee, 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. How to pay for the reimbursement of medical expenses?

On-the-job personnel are paid by medical insurance to the financial account of the unit, paid by the financial department of the unit, and retirees are paid by medical insurance to their bank cards.

3. When will the medical expenses reimbursed by hand arrive?

If the medical expenses are reimbursed manually, the medical expenses will be paid in the middle and late of the next month recorded in the Approval Form for Medical Expenses Reimbursement in Beijing issued by the Medical Insurance Center. Those who participate in Beijing urban residents' medical insurance need to pay again because of the wrong payment account number, they should first modify the payment account number at the street social security office where they live, and the medical expenses reimbursed after the account number modification will arrive in the account the next month.