The insurance editor will help you answer your questions. For more questions, you can consult online.
1. When is the medical insurance billing year?
Answer: For students enrolled in Jinhua urban area, the period is from September 1st of the current year to August 31st of the following year.
2. How to be reimbursed for medical treatment in the hospital?
Answer: Insured persons who normally enjoy the basic medical insurance benefits in Jinhua City will directly swipe their social security card for settlement when visiting designated medical institutions in the city. Medical expenses incurred in other designated medical institutions outside the urban area of ??Jinhua (limited to medical expenses incurred for hospitalization) will be reimbursed by the municipal and district medical insurance agencies.
3. What should I do if I lose my social security card?
Answer: During the period when the social security card is lost, if it is an outpatient service, the outpatient expenses must be reimbursed to the municipal or district medical insurance agency before June 20 of the same medical insurance year; if the social security card is hospitalized, the lost social security card must be used at the hospital for reimbursement. For hospitalization procedures, you need to pay the full amount in cash when you are discharged. After receiving the card, you can go to the hospital to directly settle the refund of the medical insurance pooling fund.
4. What are the regulations on the time for reimbursement of medical expenses?
Answer: Reimbursement can be accepted on normal working days. Due to annual settlement, all invoices within a medical insurance year must be reimbursed before June 20. Medical expenses incurred from June 20 to June 30 will be reimbursed in the next medical insurance year. Reimbursed in July.
5. Can the cost of buying medicines at a pharmacy be reimbursed?
Answer: When insured persons purchase medicines at pharmacies, they must bring their social security card directly to the pharmacy for settlement, and are limited to using personal accounts.
VI. How to go through the transfer procedures?
A. If designated medical institutions in urban areas need to be transferred to Class A hospitals in Hangzhou or Shanghai for treatment due to conditional restrictions, the transfer approval form should be filled in by the deputy chief physician or above of the hospital who is qualified for transfer, and it must be signed by the department director and reviewed by the hospital's medical insurance office. After the signature of the dean in charge and the seal of the unit (urban and rural residents, students, and schools), go to the Medical, Work Injury, and Maternity Benefit Settlement Section of Jinhua Social Security Bureau for review and processing. The transfer application must be processed before admission. In special circumstances, it must be processed within 7 working days after admission.
7. Which hospitals in Jinhua city can handle transfer procedures?
Answer: Central Hospital, People's Hospital, Hospital of Traditional Chinese Medicine, Guangfu Hospital, Second Hospital (limited to mental illness), Wenrong Hospital (limited to kidney transplantation and pre-transplantation examination), Fifth Hospital (limited to dermatology department) .
VIII. Can I reimburse my own medical expenses when I go abroad for medical treatment?
Answer: Yes: Normal insured persons and paying persons will be reimbursed for hospitalization expenses if they do not transfer to other places for hospitalization, visiting relatives, or going out for other reasons. The hospital where they visit is a designated hospital for local medical insurance. Medical expenses that fall within the scope of medical insurance payment are for individuals. Pay 20% out of pocket first, and then enjoy the basic medical insurance benefits in Jinhua City.
9. What is the difference between reimbursement of hospitalization medical expenses for transfer to hospital and non-transfer hospital?
Answer: 1. If the insured person is approved to be transferred to a local designated hospital for hospitalization, he will first pay 10% of the medical expenses out of pocket, and then enjoy basic medical insurance benefits according to Jinhua City regulations. For medical expenses incurred by hospitalization in a local designated hospital without going through the transfer procedures, the individual will first pay 20% out of pocket, and then enjoy the basic medical insurance treatment in Jinhua City.
X. What are the special diseases?
Answer: Malignant tumors, leukemia, aplastic anemia, chronic renal failure, dialysis treatment for uremia patients, anti-rejection treatment for organ transplantation, hemophilia, sequelae of cerebrovascular accidents (this disease is limited to Participants in basic employee medical insurance), dwarfism (this disease is limited to minors).
Xi. What are the chronic diseases?
A. Hypertension stage II (with one of heart, brain, or kidney complications), diabetes (with lower limb infection or one of heart, kidney, brain, or eye complications), liver insufficiency, cirrhosis, chronic active hepatitis, myocardium Post-infarction (combined with cardiac insufficiency, angina pectoris, and one of the complications of arrhythmia), chronic pulmonary heart disease, refractory asthma, chronic bronchitis, and cardiac function grade three (inclusive) or above. Asthma, chronic bronchitis, intraspinal space-occupying lesions, intracranial space-occupying lesions, systemic lupus erythematosus (with one of the heart, kidney, liver and nervous system complications), psychosis, tuberculosis (active stage), Rheumatoid arthritis, myasthenia gravis, Parkinson's disease, prostatic hyperplasia, hyperthyroidism, diabetes combined with hypertension.
XII. How to apply for special (chronic) diseases?
Answer: Go to Jinhua Social Security Bureau or the Medical Insurance Office of designated medical institutions to collect and fill out the "Jinhua Urban Basic Medical Insurance Special (Chronic) Disease Application and Identification Form", fill in and provide relevant information according to the requirements in the form.
13. What information is needed to apply for special (chronic) diseases?
Answer: Diagnosis certificate (secondary hospital or above), original and photocopy of discharge records or outpatient medical records related to the disease applied for in the past six months (photocopies must be stamped with official seal), documents related to the disease applied for Laboratory test data.
14. What materials are needed to handle sporadic reimbursement of medical expenses?
Answer: ●Reimbursement bill information:
(1) General outpatient reimbursement: original invoice, medical record, prescription, expense list;
(2) Chronic diseases , Special disease reimbursement: original invoice, special medical records for special (chronic) diseases, prescriptions, and expense list;
(3) Hospitalization reimbursement: original invoice, discharge record, and total expense list. Those who are transferred to a hospital for treatment must provide a transfer approval form, and those who do not need to be transferred for treatment must provide a unit certificate or explanation of the situation; those who seek medical treatment in other provinces must provide a certificate from a designated medical institution issued by the local medical insurance agency.
(4) If albumin, recombinant human erythropoietin, recombinant human granulocyte colony-stimulating factor, recombinant human granulocyte-macrophage colony-stimulating factor, or human immunoglobulin injection are used, additional information must be provided Relevant laboratory test reports for the three days before medication.
●Identity document for reimbursement (provide original and copy):
(1) If you apply for reimbursement in person, provide the social security card of the insured person (or medical card, identity card of the insured person) (certificate, bank account);
(2) If a third party applies for reimbursement of benefits transferred to the insured's account, the insured must provide the insured's social security card (or the insured's medical card, ID card, bank account) account) and the handler's ID card;
(3) If a third party handles the transfer of reimbursement benefits to the third party's account, the insured person's social security card (or the insured person's medical insurance card, ID card ), the trustee’s social security card (or bank account), ID card, and power of attorney;
(4) If the guardian handles the transfer of reimbursement benefits to a third-party account, the social security card (or The insured person’s medical insurance card, ID card, bank account), guardian’s household register, ID card, social security card (or bank account);
(5) If the legal heir applies, provide the insured person’s social security card ( Or the insured person’s medical insurance card, ID card, bank account), legal heir relationship certificate, ID card, death certificate or cremation certificate of the deceased, and other relevant information.
15. What medical benefits do insured persons enjoy after hospitalization reimbursement?
Answer: 1. Within a medical insurance year, if the insured person meets the prescribed hospitalization expenses, the individual will first bear a certain amount (i.e., the minimum payment standard), and the minimum payment standard will be halved for students who are in school and minors who are not in school. That is, 500 yuan for the central hospital; 350 yuan for tertiary medical institutions such as the Municipal Traditional Chinese Medicine Hospital, People's Hospital, Second Hospital, and Guangfu Hospital; 250 yuan for second-level medical institutions; 150 yuan for first-level medical institutions; and 500 yuan for designated medical institutions outside the urban area. . For hospitalization for the second and subsequent times in the same medical insurance year, the deductible is calculated as 50% of the deductible for the first hospitalization. The maximum annual payment limit for hospitalization is 150,000 yuan.
Medical expenses between the minimum payment standard and the maximum payment limit for residents will be borne by the overall fund and individuals respectively. Those who pay according to Category I standards, school students and minors who are out of school seek medical treatment in first-level medical institutions, and 85% of the medical expenses are reimbursed; those who seek medical treatment in second-level medical institutions, 80% of the medical expenses are reimbursed; 75% of the medical expenses will be reimbursed; those who pay according to Category II standards (except school students and minors who are out of school) seek medical treatment in first-level medical institutions, and 75% of the medical expenses will be reimbursed. If minors) seek medical treatment in first-level medical institutions, 80% will be reimbursed; if they seek medical treatment in second-level medical institutions, 70% will be reimbursed; if they seek medical treatment in third-level medical institutions, 65% will be reimbursed.
16: What kind of medical treatment do insured persons enjoy when receiving reimbursement from general outpatient clinics?
Answer: 50% reimbursement for medical treatment at Jinhua Urban Community Health Service Center, and 20% reimbursement for medical treatment at secondary (inclusive) or above medical institutions. The maximum proportional contribution of the overall fund and individuals in a medical insurance year is 1,500 yuan. In other words, a maximum of 750 yuan can be reimbursed in a medical insurance year.
The overall fund will not pay for ordinary outpatient medical expenses incurred outside the urban area (except for those who are placed in other places or transferred to hospitals according to regulations).
17. What medical benefits do insured persons enjoy for outpatient chronic disease reimbursement?
Answer: 1. In a medical insurance year, the maximum limit of proportional contributions from the overall fund and individuals is 2,000 yuan. 60% of outpatient medical expenses for chronic diseases within the prescribed range will be reimbursed by the basic medical insurance fund.
18. What medical benefits do insured persons receive from outpatient reimbursement for special diseases?
Answer: 1. The minimum payment standard within an insurance year is 500 yuan, and medical expenses above the minimum payment standard are paid according to hospitalization standards.
19. How are students reimbursed for medical treatment? How do students reimburse outpatient expenses if they have an accident?
Answer: After a student has an accident, he should first call the Jinhua Life Insurance reporting hotline (95519) to register, and then go to the life insurance company for reimbursement with valid documents such as medical records, outpatient medical fee invoices, etc. The specific process is as follows: (1) Accidental injury outpatient medical insurance benefit is RMB 10,000, and outpatient medical expenses will be paid at a rate of 90%; (2) Accidental injury death insurance benefit is RMB 100,000; Illness death insurance benefit is RMB 100,000; (3) Accidental injury disability The insurance premium is 100,000 yuan and will be paid according to the disability ratio listed in the "Personal Insurance Disability Degree and Insurance Benefit Ratio Table" issued by the People's Bank of China. The reimbursement location is the China Life Business Hall on the first floor, No. 633 Danxi Road, Jiangnan District, Jinhua City. The consultation hotline is: 82492849.
Students who are hospitalized for accidental injuries must bring discharge records, expense lists, invoices, and certificates issued by the school’s medical insurance office to the Jinhua Municipal Social Security Bureau for reimbursement. The consultation phone number of the Jinhua Municipal Social Security Bureau’s reimbursement office is: 0579-82822079, Jinhua Municipal Social Security Bureau Inquiry telephone number of the bureau's reimbursement office: 0579- 82822079. 82822079, Jinhua Social Security Bureau address: Public Administration Building, No. 289 Danxi Road, Jinhua City.
20. What benefits can insured persons who have purchased large-amount medical supplementary insurance enjoy?
Answer: (1) Reimbursement benefits that exceed the maximum payment limit of basic medical insurance: The large supplementary insurance benefits for insured persons are linked to the number of consecutive purchase years, in the first year
Reference: