Medical insurance refers to social medical insurance, which is a social insurance system established to provide basic medical needs for workers within the scope of protection. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. In this paper, please introduce the related knowledge of Jiaxing medical insurance reimbursement. It mainly includes Jiaxing medical insurance reimbursement process, Jiaxing medical insurance reimbursement ratio and Jiaxing medical insurance reimbursement policy.

First, Jiaxing medical insurance reimbursement process and the required materials for hospitalization medical expenses reimbursement:

1, original invoice of hospitalization medical expenses;

2, medical expenses summary list;

3. Discharge summary;

4. A copy of the Medical Card.

Outpatient medical expenses reimbursement:

Show the original invoice after the hospital confirms and seals it.

Reimbursement process hospitalization medical expenses reimbursement:

1, the insured is hospitalized in a designated hospital, which meets the reimbursement requirements and is reported in real time by credit card;

2, does not meet the real-time reporting conditions (such as trauma, etc.). ) and hospitalized in a designated hospital outside the city, with the above materials to the town (street) medical office to apply, by the town (street) medical office after the preliminary examination, once a week reported to the city medical office, the city medical office after receiving the reimbursement materials 10 working days to complete the audit report.

Note: Those who do not apply for compensation within 3 months after the end of the year will give up automatically.

Outpatient medical expenses reimbursement:

Credit card real-time report. Outpatient expenses that are not reported in real time due to hospital reasons shall be confirmed and stamped by the hospital, and the original invoice shall be used to apply for compensation to the town (street) joint medical office on a regular basis.

Note: Outpatient expenses that are not swiped in real time without special reasons will not be reimbursed.

Two, Jiaxing City, the proportion of medical insurance reimbursement for employees and related policies.

Participate in the unified account of basic medical insurance for employees:

Reimbursement of hospitalization medical expenses:

Qifubiaozhun: First-class and below medical institutions (community health service institutions) in 300 yuan, second-class (county-level) medical institutions in 500 yuan, and third-class (city-level) medical institutions in 800 yuan.

Reimbursement ratio:

The part above Qifubiaozhun to below the maximum payment limit shall be paid by the overall fund according to the following proportion:

90% of medical institutions (community health service institutions) at or below the first level; Secondary (county-level) medical institutions are 85%; Three (municipal) medical institutions for 80%.

Outpatient medical expenses reimbursement:

Qifubiaozhun: outpatient Qifubiaozhun: employee 500 yuan, retiree 300 yuan;

Reimbursement ratio:

1. The outpatient (emergency) medical expenses incurred by the insured in the community health service center (station) where the national basic drug system is implemented, which meet the payment scope stipulated by the basic medical insurance, shall be paid by the overall fund from the outpatient Qifubiaozhun to the outpatient maximum payment limit by 70%;

2, in other designated medical institutions (retail pharmacies) in line with the provisions of the basic medical insurance payment scope of outpatient (emergency) diagnosis (drug purchase) costs, in the outpatient Qifubiaozhun above to the outpatient maximum payment limit below, by pooling funds according to the proportion of 40% payment.

Participate in the basic medical insurance system for employees II:

Reimbursement of hospitalization medical expenses:

Qifubiaozhun: First-class and below medical institutions (community health service institutions) in 300 yuan, second-class (county-level) medical institutions in 500 yuan, and third-class (city-level) medical institutions in 800 yuan.

Reimbursement ratio:

The part above Qifubiaozhun to below the maximum payment limit shall be paid by the overall fund according to the following proportion:

90% of medical institutions (community health service institutions) at or below the first level; Secondary (county-level) medical institutions are 85%; Three (municipal) medical institutions for 80%.

Outpatient medical expenses reimbursement:

Qifubiaozhun: 500 yuan, an on-the-job employee, and 300 yuan, a retiree;

Reimbursement ratio:

1. The outpatient (emergency) medical expenses incurred by the insured in the community health service center (station) where the national basic drug system is implemented, which meet the payment scope stipulated by the basic medical insurance, shall be paid by the individual account in the current year, and included in the part that is insufficient to be paid by the individual account in the current year. The part above the outpatient Qifubiaozhun and below the maximum payment limit for outpatient services shall be paid by the overall fund according to the proportion of 80%;

2, in other designated medical institutions (retail pharmacies) in line with the provisions of the basic medical insurance payment scope of outpatient (emergency) consultation (medicine) costs, first included in the annual personal account payment, and then included in the personal account insufficient payment, in the outpatient Qifubiaozhun above to the outpatient maximum payment limit below, by the overall fund according to the proportion of 50% payment.

Urban and rural residents

Reimbursement of hospitalization medical expenses:

Qifubiaozhun: first-class and below medical institutions (community health service institutions) 300 yuan, second-class (county-level) medical institutions 500 yuan, third-class (city-level) medical institutions 1000 yuan; Three-level medical institutions outside the city 2000 yuan, other medical institutions outside the city 2500 yuan.

Reimbursement ratio:

Above Qifubiaozhun and below the maximum payment limit: medical institutions (community health service institutions) with 80% fund payment ratio; Secondary (county-level) medical institutions, the fund payment ratio is 75%; For tertiary (municipal) medical institutions, the proportion of fund payment is 65%.

Outpatient medical expenses reimbursement:

Reimbursement ratio: the reimbursement ratio of the first-level and below medical institutions (community health service institutions) that implement the national essential drug system is 50%, the reimbursement ratio of the second-level (county-level) medical institutions is 15%, and the reimbursement ratio of the third-level (municipal) medical institutions is 10%. Outpatient medical expenses incurred by medical institutions outside the region shall not be paid.

The scope of reimbursement The following medical expenses are not included in the payment scope of the basic medical insurance fund for employees:

(1) paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) It should be borne by public health;

(4) Going abroad for medical treatment;

(5) Self-injury caused by intentional crime;

(6) Non-basic medical needs such as beauty and plastic surgery occur;

(7) Non-basic medical insurance designated medical institutions (designated retail pharmacies);

(8) Other laws and regulations do not provide for payment.