What do you need to bring to the medical insurance center for re
Social medical insurance reimbursement is after discharge or transfer
settlement proceres for inpatients and outpatients with special diseases:
designated medical institutions shall report the expense settlement sheet, inpatient settlement sheet and relevant information of discharged patients in the previous month to the medical insurance agency before the 10th day of each month, which will be used as the basis for monthly budget and year-end final accounts after being reviewed by the medical insurance agency
medical insurance agencies pre allocate the overall expenses of hospitalization and outpatient treatment of special diseases in the previous month
the insured with special diseases should go to a designated medical institution designated by the labor and social security department for medical treatment and purchase, and the medical expenses incurred should be directly recorded and settled immediately
emergency settlement procere: the medical expenses incurred by the insured who are hospitalized in non designated medical institutions and other medical institutions in the city e to emergency rescue shall be paid in advance by the indivial or unit. After the end of emergency rescue, the reimbursement proceres shall be handled by the medical insurance agency according to the regulations with the hospital emergency medical records, examination, laboratory report, invoice and detailed medical charge list
settlement procere for off-site resettlers:
the unit where the off-site resettlers are located shall designate 1-2 designated medical institutions for them and report them to the medical insurance agency for record
the medical expenses incurred by the staff in different places who are ill in the designated medical institutions of their residence shall be paid by themselves or their units in advance. After the treatment, their units shall go to the social medical insurance agency for settlement with the medical certificates and medical records of the insured, valid expense bills, plicate prescriptions, hospitalization expenses list, etc. on the specified date
referral settlement:
if the insured is transferred to other medical institutions for diagnosis and treatment e to the limited conditions of designated medical institutions or special diseases, they need to fill in the referral approval form. The reason for referral should be put forward by the doctor in charge, the director of the Department should put forward the opinion of referral, the medical insurance office of the medical institution should review, the president in charge should sign and report to the Municipal Medical Insurance Center for approval
in principle, referral should be made from within the city to outside the city, from within the province to outside the province. It is stipulated that referral within the city should be concted among designated medical institutions. Referral outside the city shall be proposed by designated medical institutions at or above the third level of the city
for the medical expenses incurred by the insured after referral, the indivial or unit shall pay in cash first. After the medical treatment, the insured or his agent shall go to the medical insurance agency for reimbursement of the hospitalization expenses within the scope of the overall planning fund with the referral approval form, medical record certificate, prescription and valid documents
The original of the original charge data sheet, the original of the expense detail sheet, the original of the outpatient medical record, the original of the diagnosis, the emergency hospitalization certificate, the original of the social security card, the original of the ID card (the agent's ID card should also be provided), the original of the bank account (passbook or bank card is OK), Original unit certificate
if the applicant wants to apply for the reimbursement of the second level hospitalization expenses of medical insurance, he needs to meet the following conditions:
1. He has gone through the insurance proceres, paid the medical insurance expenses in full on time, and the insurance time is on the 1st of the next month
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3. When the insured went to the medical institutions that had been registered, they had incurred hospitalization expenses, which had been paid in advance, and had the corresponding medical expense documents and hospitalization materials
reimbursement process:
first, the applicant needs to go through the reimbursement application proceres, and then submit the relevant application materials required for reimbursement. The place of submission of materials is the medical insurance Department of the social security branch of the Social Security Fund Management Bureau
after receiving the reimbursement application from the applicant, the acceptance Department of the administration will check the application materials provided by the applicant within 5 days from the date of receiving the materials, and decide the final acceptance result
if the application materials are wrong or incomplete, the acceptance department will inform the applicant and inform him to prepare the required materials at one time within 5 days, and correct the wrong contents in the materials
and the applicant should complete the material correction within 5 days from the date of receiving the notification of material correction. If the time limit is exceeded, no correction will be made and the application will be withdrawn
if the materials have been supplemented and corrected within the time limit, the application can be reapplied within the validity period of medical insurance reimbursement
is a problem that many people are concerned about
in fact, there are many people around us who lack the correct way to open medical insurance
this is not a chance to collect the socialist wool<
aunt Baiyun is optimistic about you ~
today, let's talk about the correct way to open medical insurance reimbursement
first, what is medical insurance
a social insurance system established to compensate workers for the economic losses caused by disease risks<
through the payment of employers and indivials, the medical insurance fund is established.
after the medical expenses of the insured are incurred, the medical insurance institution will give them certain economic compensation<
the establishment and implementation of the basic medical insurance system has gathered the economic strength of the units and members of the society.
coupled with government subsidies, the sick members of the society can get the necessary material help from the society,
rece the burden of medical expenses, and prevent the sick members of the society from "poverty caused by illness"
to put it bluntly, when we are sick, the state pays to help us see a doctor to rece the financial burden of migrant workers.
moreover, there is no requirement for the insured population< Second, there are two ways of payment: one is the medical insurance for urban employees paid by ordinary office workers who have signed labor agreements, and the other is the social security that the state forces employers to pay,
the amount of payment is composed of two parts:
one is a part of the company's payment (accounting for the majority)
one is a part of the indivial's responsibility (accounting for the minority)
the other is the medical insurance for urban and rural residents paid by unemployed or self-employed people
this medical insurance for urban and rural residents is to integrate the medical insurance for urban residents and the new rural cooperative medical system, Establish a unified medical insurance system for urban and rural residents
this system enables both rural and urban residents to participate in the insurance
but the fees need to be paid by themselves, and the amount paid is less than the employee's medical insurance, but it is not mandatory
moreover, the payment standard of medical insurance in each city is different, which should be subject to the local medical insurance management center
how to pay<
1. Medical insurance for urban employees
generally, employers and indivials should pay the percentage of the local social security base (or a certain salary) every month,
the money will be directly dected from the salary,
the insured men are over 60 years old and women are over 55 years old,
the payment period for men is not less than 25 years, Women should pay for no less than 20 years,
among them, the actual payment of basic medical insurance must be no less than 15 years, and they can enjoy medical insurance benefits after retirement
if the minimum number of years is not met before retirement, the medical expenses of the actual payment years can be made up at one time
however, it still depends on whether the local government has a supplementary payment policy<
2. The payment fee of medical insurance for urban and rural residents is much lower than that for urban employees.
there is no requirement for the payment period of medical insurance for urban and rural residents, and they can enjoy one year's treatment if they pay one year's fee
however, when the employee's medical insurance reaches the retirement age, it must be paid for at least 25 years
the premium is paid once a year. In principle, the payment time is from July to December of each year.
the next year of payment, the urban and rural residents enjoy medical insurance treatment.
there is no retirement treatment for urban and rural residents, but the government will also give certain subsidies<
Third, reimbursement ratio
because the two kinds of medical insurance pay different fees, so they enjoy different treatment.
employees pay more insurance premiums, so their treatment is relatively better.
the reimbursement ratio of employees' medical insurance is 10% - 20% higher than that of residents' medical insurance<
for example,
my father was in business in his early years, and now he doesn't work at home
and he doesn't reach the retirement age,
so he paid local residents' medical insurance
but his old friends all paid employee's medical insurance
every time he came back from the hospital, he would complain to me that the reimbursement rate was too low,
goes to the 52 level bookstore in the Shanghai Center: the Shanghai flagship store (the highest bookstore in Shanghai) does not need to make an appointment. Strong> but for the large passenger flow, the lobby on the first floor of Shanghai center will be limited. If there are more than 350 people in the bookstore, the building will start warning. Therefore, there will be a special place in the building for people waiting there to line up. The staff of the bookstore are waiting at the elevator entrance. An elevator can take about 18 people. The staff of the bookstore upstairs inform the staff of the elevator queue of the number of people who can go upstairs according to the passenger flow in the store