The same is true for buying medicine. Only designated pharmacies with medical insurance can swipe their medical insurance cards to buy medicines, and other pharmacies can only pay their own money.
2. Don't transfer to another hospital without permission.
Some diseases can't be seen in designated medical institutions. If you want to go to a better hospital for treatment, you must first apply for referral, and the referral with complete procedures can be reimbursed; If you don't apply for referral, it is still equivalent to going to a designated medical institution that you have no choice, and you still can't reimburse. There is often a gap in the reimbursement ratio. Generally speaking, the higher the level of hospital treatment, the lower the reimbursement rate.
3. The deductible can only be applied for medical insurance if it crosses the line.
Medical insurance has a deductible, and you can only reimburse it if you pay that amount first. For example, X stipulates that the outpatient deductible line is 1.800 yuan, and if the total amount of outpatient medical treatment in one year is less than 1.800 yuan, all the money must be paid by yourself; And if it exceeds 1800 yuan, it can be reimbursed. At the same time, medical insurance also has a cap line, which means that medical insurance can give you the most money, and the excess money cannot be reimbursed.
4. Some medicines cannot be reimbursed.
The drugs reimbursed by medical insurance are specific, and only drugs in the medical insurance catalogue can be reimbursed, but drugs outside the medical insurance catalogue cannot be reimbursed, such as many expensive imported innovative drugs and patented drugs. So communicate with the doctor before taking medicine. If you want to save money, use the medicine in the catalogue.
5. Some special surcharges cannot be reimbursed.
It is common to be hospitalized in your private room or to ask for special services, such as specialized doctors and nurses. These are not reimbursable. If you really have special needs, pay for it yourself.
6. Be careful not to exceed the time limit for reimbursement.
Social security card must be used to settle all kinds of expenses when leaving the hospital. Special circumstances can not be settled immediately, you can later take documents and vouchers to the medical insurance department for manual reimbursement of medical expenses. But we must hurry up at this time, because there is often a time limit. For example, some local medical insurance departments will conduct liquidation before the end of the year, and they will not be reimbursed after the deadline. Don't forget to reimburse the medical expenses because of carelessness. You can only bear these expenses yourself after the deadline. Based on the actual situation.
Legal objectivity:
1. What does medical insurance reimbursement mean? In short, part of the expenses you pay for medical treatment is borne by the state or unit, and the part you pay is called reimbursement. China's medical insurance is divided into two parts: individual account and social pooling fund, which are jointly funded by units and individuals in accordance with the prescribed proportion to ensure citizens' basic medical needs. Among them, the overall fund is used to pay the hospitalization expenses, the personal account is used to pay the outpatient and emergency expenses and the drug purchase expenses of designated retail pharmacies, and the expenses that need to be borne by individuals in specific projects of hospitalization and outpatient services are also paid by personal accounts. If the funds in personal accounts are insufficient, they will be paid by individuals. 2. Reimbursement proportion range 1, outpatient and emergency medical expenses: the part that meets the requirements of basic medical insurance in the employee's year (11February 31February) exceeds 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. After paying medical insurance for 20 years, you can enjoy medical insurance reimbursement after retirement.