1, outpatient and emergency medical expenses: The medical expenses that meet the requirements of basic medical insurance for employees in the current year (65438+ 10/kloc-0+February 3 1) totaled more than 2,000 yuan.
2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.
3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate.
4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement.
5. Hospitalization: Medical insurance has been paid for 20 years, and medical insurance reimbursement can only be enjoyed after retirement.
Not covered by medical insurance reimbursement:
1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care and medical expenses that do not meet the requirements of family planning;
2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses;
3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;
4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;
5, within the scope of reimbursement, beyond the limit.
You must know how to use the medical insurance card:
I believe many people have medical insurance cards. There are some things that should be paid special attention to during use, otherwise you will suffer from YaBaKui!
If you are seriously ill and need hospitalization, it will be easy. Give the card to the hospital and you can be treated with peace of mind. It doesn't matter if Cary has no money. When leaving the hospital, the hospital will settle accounts with the medical insurance center, and individuals only need to bear one-third of the expenses.
What if you go to the clinic? Then you have to use the balance in your card to pay for the outpatient service. What if the balance in the card is all used up? From your own pocket. Not bad. However, when our self-funded amount exceeds 1200 yuan, the excess can be reimbursed, accounting for 60%. For example, the outpatient expenses are 2000 yuan, and the excess 800 yuan can be reimbursed to 480 yuan. Individuals only bear the direct settlement from 320 yuan, hospitals and medical insurance centers, so don't worry about this. But please note: you must go to the community hospital before going to the hospital. This process must not be omitted! Otherwise, even if you spent 18 thousand, I'm sorry, I didn't reimburse a penny, all at my own expense!
I am afraid many people don't know this rule. You only need to transfer to a community hospital once a year, so please transfer to a large general hospital, and then transfer to a Chinese medicine hospital every January to facilitate future treatment. There is no need to transfer to specialized hospitals, such as brain hospitals, chest hospitals, tumor hospitals, stomatological hospitals, etc. Because these hospitals are irreplaceable. The self-paid part can be accumulated. As long as it reaches 1200 yuan every year, the excess part can be reimbursed in proportion.