List of reimbursement scope and proportion of urban medical insurance in Hefei. The following is a list of the scope and proportion of urban medical insurance reimbursement in Hefei. I hope the following consultation can help your life.
Hefei urban medical insurance reimbursement scope:
1. What is the threshold fee for hospitalization?
Answer: The insured person should take his social security card to the designated medical institution for the first time. Within the scope of medical insurance, the Qifubiaozhun for hospitalization in the first-class (and below), second-class and third-class hospitals in this city are 200 yuan, 400 yuan and 600 yuan respectively.
2. What is the proportion of reimbursement for hospitalization medical expenses?
Answer: Within the scope of medical insurance, within one year, the proportion of the insured's hospitalization medical expenses above the threshold and below 60,000 yuan is 6% in the first-class hospital, 8% in the second-class hospital and 10% in the third-class hospital. For retirees and employees who have worked for more than 30 years, the proportion of individual commitment will be halved. 600,000-300,000 yuan shall be borne by 4% of individuals, and some funds above 300,000 yuan shall not be paid.
3. How is the medical insurance medicine prescribed in hospital prescribed?
Answer: According to the List of Drugs for Basic Medical Insurance and Work Injury Insurance in Anhui Province, the drugs used by the insured in hospital are divided into Class A drugs and Class B drugs. The expenses incurred in using Class A drugs shall be paid according to the provisions of basic medical insurance. For the use of Class B drugs, the insured pays a certain proportion first, and the rest is paid according to the provisions of basic medical insurance. The use of drugs outside the drug list will not be reimbursed by the medical insurance fund.
4. How to understand the out-of-pocket expenses and out-of-pocket expenses on the medical insurance statement?
A: Out-of-pocket expenses refer to the expenses that individuals should bear within the scope of medical insurance, including the minimum payment standard (threshold fee) of the overall fund and the expenses paid by individuals in Class B drugs and medical materials. Out-of-pocket expenses refer to expenses outside the medical insurance catalogue. Designated hospitals should inform the insured in advance when using drugs and medical materials outside the medical insurance catalogue.
5. What should I do if I need to be transferred to another hospital?
Answer: If the insured's disease is difficult to be diagnosed in the highest-level designated hospital in this city or there is no effective treatment, it can be transferred to the designated medical institution for basic medical insurance for foreigners for treatment. When transferring to another hospital, the insured must submit the Application Form for Transfer of Basic Medical Insurance for Urban Workers in Hefei issued by the designated hospital to the Municipal Medical Insurance Center for the record (3rd floor, No.88, District Government Ring Road, municipal government, tel: 3536433, 3536 1 165438).
6. What should I do if I need hospitalization for sudden illness in other places?
List of compensation standards:
Answer: Insured persons who need to be hospitalized in different places due to sudden illness should be hospitalized in local designated medical institutions and contact the Municipal Medical Insurance Center (Tel: 353611) for registration and filing within 3 working days after admission. Expenses that do not go through the formalities according to regulations will not be reimbursed.
7. How to apply for outpatient special disease treatment?
Answer: Those who suffer from 25 kinds of diseases such as hypertension, diabetes, etc. and need to take medicine for daily outpatient treatment can apply to the Municipal Medical Insurance Center for a special disease outpatient card (at the intersection of Lujiang Road and Jinzhai Road on the third floor of the former Municipal Labor and Social Security Bureau, telephone number 26 13036).
Medical insurance is like a huge pool of funds. Some people keep putting money into it, and some people take money from it. As long as there is a balance in the fund pool, the insured can alleviate certain economic pressure when he is sick.
How to reimburse Hefei social medical insurance
I know the details of how to reimburse medical insurance.
Social medical insurance reimbursement flow chart
Hefei medical insurance reimbursement instructions:
Insured persons can purchase medicines at designated medical institutions and retail pharmacies with medical insurance cards, and their medical expenses can be settled directly by credit card. When purchasing drugs, they are not included in the overall social planning, and all of them are paid by personal accounts. If the personal account runs out of funds, you can pay in cash.