2. Print social security in official website: use a computer browser (GoogleChrome version 94.0.4606.6 1) to log in to the local human resources and social security network, and enter information such as ID number and verification code to query and print.
3. The medical insurance reimbursement list is in the hospital settlement window. Make a list when you check out, and then the hospital seals it.
The medical insurance statement refers to the list of materials submitted by the designated medical institutions for medical insurance to apply for fee settlement to the medical insurance department after carrying out medical services such as hospitalization and outpatient service.
Medical insurance is insurance to compensate medical expenses caused by diseases. Social insurance in which employees are provided with necessary medical services or material assistance by society or enterprises due to illness, injury or childbirth.
Medical insurance refers to the insurance that pays the insurance premium on the condition that the medical behavior agreed in the insurance contract occurs, and provides protection for the medical expenses of the insured during the medical treatment [1].
Medical insurance has the basic characteristics of social insurance, such as compulsion, mutual assistance and sociality. Therefore, the medical insurance system is usually enforced by national legislation and a fund system is established. The expenses are paid jointly by the employer and the individual, and the medical insurance premium is paid by the medical insurance institution to solve the medical risks caused by the illness or injury of the employees.
Medical insurance, like other types of insurance, collects medical insurance premiums from people threatened by diseases in advance in the form of contracts and establishes medical insurance funds; When the insured goes to a medical institution for medical treatment, the medical insurance institution will give him some economic compensation.
Therefore, medical insurance also has two functions of insurance: risk transfer and compensation transfer. That is, the economic losses caused by individual disease risks are distributed to all members threatened by the same risks, and the economic losses caused by diseases are compensated by centralized medical insurance funds.
Medical insurance card reimbursement ratio
1. reimbursement ratio: the minimum payment for the first hospitalization in a natural year 1300 yuan, with 650 yuan as the unit each time. The payment ratio is divided into three grades. Take a tertiary hospital as an example. The floating standards are: 30,000 yuan, 85% on the job, 9 1% for retirement, 90% for 30,000-40,000, 94% for retirement, more than 40,000, 95% for employment and 97% for retirement.
2. 90 days of general hospitalization is a settlement cycle. Psychiatric hospitalization for 360 days is a settlement cycle, and the floating standard is halved. In a natural year, the overall fund pays a maximum of 70,000 yuan. The maximum hospitalization amount is 654.38+10,000 yuan, and the hospitalization ratio is 70%;
3. Reimbursement scope: hospitalization expenses incurred by the insured in designated hospitals or specialized hospitals, traditional Chinese medicine hospitals and tertiary hospitals selected by the individual;
4. Medical treatment management: if the unit pays the full fee, the individual can go through the hospitalization formalities only by paying part of the hospitalization advance payment. The medical expenses incurred should conform to the scope of the three major catalogues of medical insurance;
5. Reimbursement process: At the time of discharge, the hospital and the individual settle the self-funded and self-funded amount, and the reimbursement amount of the overall fund is settled by the hospital and the district medical insurance center.
At present, the arrival time of medical reimbursement usually has the following two situations. First of all, it will arrive in a short time, immediately at the time of reimbursement settlement or within a few days. As long as the insured brings all relevant materials to the designated place for reimbursement, the reimbursement fee will be paid directly in cash or remitted to the account designated at that time. The other is a long time, usually within 1-2 weeks or even 1-3 months. If medical insurance is settled in different places, medical insurance reimbursement can be received in real time. Whether the medical insurance patients in different places in the province can directly settle the hospitalization expenses in the hospital depends on the actual credit card information of the patient's medical insurance card. In the process of handling, if there is anything unclear, you can go to the hospital medical insurance office for consultation.
Legal basis:
"People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Settlement procedures for hospitalization and outpatient treatment of special diseases: Before 10 every month, the designated medical institutions will report the expense list, hospitalization list and related materials of the patients discharged last month to the medical insurance agency, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination; The medical insurance agency pre-allocated the hospitalization and outpatient co-ordination expenses for special diseases last month; Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately. Emergency settlement procedure: the medical expenses incurred by the insured in emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall go through the reimbursement procedures according to the provisions with the hospital emergency medical records, inspections, laboratory tests, invoices and detailed list of medical expenses.
The time when the annual medical insurance payment reaches the account: This is related to the time when the party's unit completed the annual social security audit and the work efficiency and process of the social security institution, and cannot be generalized.
1. After the local government announced the average salary of employees in the previous year, the social security determined the upper and lower limits of the local payment base for this year, and the social security payment base for social security participants and employers was determined by each employer within the payment base range determined by this year's social security.
2. After receiving the company's data information, Social Security will conduct an audit. After passing the examination, the employer completes the annual examination, and the social security agency confirms its payment base;
3. The social security agency shall determine the specific amount of the client's account according to the annual payment base of the client and the local age ratio of the client;
4. After the social security performs the examination and approval procedures, the increased amount will be included in the medical insurance card of the party concerned.