Today, Chayue Social Security will talk to you about the expenses on the outpatient bill.
First of all, we need to know the meaning of each item on the document so as to better understand how our medical expenses are settled. Here, take the bill of a medical clinic of an employee of Chayue Social Security as an example:
Cha Yue Social Security paid the medical insurance for urban workers in Beijing. It is understood that the employee has gone through the formalities of medical treatment in different places in advance, so the reimbursement for medical treatment in different places can be settled in real time. For more detailed information about medical treatment in different places, click on the article to understand → do these three steps well, and medical insurance can directly settle medical treatment in different places!
We can see basic personal information, including name, gender, medical insurance type, social security card, etc. , will be indicated on the outpatient bill. When you get the bill, you should first verify whether the information is correct.
Let's look at the details of the project. Here, we will indicate the details and reimbursement level of the treatment fee, medical fee, operation fee, material fee and other expenses of this outpatient service. There are three categories:
Non-self-payment: refers to the expenses fully reimbursed by the medical insurance fund in proportion; Out-of-pocket: refers to the expenses that the individual bears part of the expenses and the rest is reimbursed by the medical insurance fund in proportion; Full self-payment: refers to the part that is completely self-funded, and the expenses that are not reimbursed by medical insurance.
Secondly, look at the fund or fund payment part:
Large outpatient payment: the amount paid by the medical insurance fund in accordance with the regulations. Supplementary pension: the amount of supplementary pension paid in accordance with the regulations. Payment of disabled soldiers grant: the amount of disabled soldiers grant paid in accordance with regulations in this fee. Unit Supplementary [Original Public Benefits]: the amount paid by the unit supplementary [Original Public Benefits] fund according to regulations in this expense. Amount within the scope of this medical insurance: the total amount of expenses that can be included in the scope of medical insurance payment in this expense. Cumulative amount within the scope of medical insurance: up to the current expense settlement, the cumulative amount within the scope of medical insurance in this year. Annual large-sum accumulative payment for outpatient service: refers to the amount of accumulative reimbursement for outpatient service by medical insurance fund in this year up to this expense settlement. Personal account balance after this payment: personal account balance until this expense settlement.
Then, let's look at the amount of individual contributions:
Out-of-pocket 1: refers to the amount that individuals should bear in proportion within the scope of medical insurance, including the minimum payment and the large cap amount outside the year. Deductible: refers to the amount below the deductible in medical insurance coverage among the medical expenses incurred in this visit. Cap amount: refers to the amount within the medical insurance scope above the annual cap line in the medical expenses incurred this time. Self-funded 2: refers to the self-funded drugs, examinations, treatments and materials within the scope of medical insurance, which need to be borne by individuals first. Out-of-pocket: refers to the examination or drugs that are not covered by medical insurance, and all the expenses paid by individuals are paid by funds: the amount paid by funds according to policies. Personal account payment: according to the policy, personal account is used to pay the medical expenses of the insured. Personal payment amount: refers to the amount of personal burden that the insured person needs to pay this time.
The treatment fee 4 yuan and medical fee Yuan listed in the list are self-paid, and part of the operation fee is 9 19 yuan, so the amount within the scope of this medical insurance reimbursement is RMB, and the insured's accumulated medical insurance coverage this year is RMB, which has reached the deductible line of Beijing medical insurance reimbursement 1800 yuan. According to the proportion of medical insurance reimbursement for employees in Beijing 3A hospitals, the amount of medical insurance payment for this outpatient service is × 70% =.
The following list is the outpatient registration reimbursement form. The medical service fee in the project is equivalent to the registration fee. The charging standard of medical service fee is related to the level of medical institutions served.
Outpatient medical service fees shall be reimbursed in a fixed amount, and the medical service fees incurred by the insured shall be reimbursed according to the regulations, and shall not be restricted by the deductible line and the capping line. 40 yuan, the general outpatient service of tertiary hospitals, 28 yuan, the general outpatient service of secondary hospitals, and 19 yuan, the general outpatient service of first-class and below medical institutions.
As can be seen from the above documents, the level of medical service fee for this visit is a tertiary hospital, and the cost is 50 yuan. According to the reimbursement regulations for outpatient medical service fees, the reimbursement amount within the scope of this medical insurance is 40 yuan, and the individual payment amount is 10 yuan.
Of course, due to the differences of medical insurance policies in different places, some items on the bill of medical outpatient expenses may not be unified nationwide. The bill in this article is for reference only. If the insured person doesn't understand the relevant policy of "real-time settlement of medical treatment by card", he can consult the local hospital or medical insurance department to find out the specific content.