The insurance editor will help you answer your questions. For more questions, you can answer them online.
1. Medical insurance is divided into two accounts. The personal account, the money reflected in the medical insurance card, can be used to buy medicines at designated pharmacies, pay for outpatient expenses and pay for the personal out-of-pocket portion of hospitalization expenses; The overall account is managed by the medical insurance center. Expenses incurred by the insured that are reimbursed by local medical insurance are paid from the overall account
2. When seeking medical treatment, present the medical insurance card to the designated hospital to prove your insured status and registration. The part reimbursed by medical insurance is settled by the medical insurance and the hospital. Individuals do not need to pay first and then be reimbursed. At the time of checkout, the individual's self-payment is paid by himself using the balance of his medical insurance card and cash
3. Hospitalization reimbursement At that time, there was a minimum payment line (the minimum payment standard was generally 10% of the average annual salary of the city's employees in the previous year), which means that the minimum payment line needs to be paid by oneself, and the portion exceeding the minimum payment line can be paid according to the local medical insurance regulations. Reimbursement and reimbursement ratios vary from place to place, and different hospitals and different projects are also different. I can’t give you the details, but it’s about 80%. For details, you can go to the local labor and social security website to learn more.
For newly insured people, it takes two months to get the card. Are you applying for urban employee medical insurance, resident medical insurance, or flexible employment employee medical insurance? Different types of enjoyment have different proportions and times. Take the flexible employment medical insurance, which requires normal payment for half a year before you can enjoy hospitalization.
No matter what kind of medical insurance, if you need outpatient medical treatment or hospitalization, you must go to a designated hospital - a designated hospital for medical insurance (or a designated hospital for residence insurance). Such hospitals use a unified medical insurance system to read cards.
The so-called "reimbursement" for medical treatment by medical insurance card is not the original idea of ??claiming cash with an invoice, but the medical insurance system reads the card to identify the payment status and identity of the cardholder, and pays in the outpatient department or discharges from the hospital. During settlement, the system automatically debits the personal account amount on the cardholder's medical insurance card or collects cash from the patient according to the payment ratio stipulated in the document. In other words, if you use the medical insurance card to see a doctor without paying cash or paying less cash, the social security will be paid to you." "Reimbursed".
As for the specific payment ratio and scope restrictions, there are many. For example, drugs and treatments are divided into Category A, Category B, self-pay, etc., and the "reimbursement ratio" is different; the "threshold fee" for hospitalization is different at different hospital levels; within the year The "threshold fee" for the first hospitalization is different from that for subsequent hospitalizations; the "reimbursement ratio" is different between in-service and retired; the "reimbursement ratio" is also different between civil servants and non-civil servants... In any case, all "reimbursement" conditions are unified The medical insurance system is set up and will not be changed due to personal reasons or hospital reasons