Uniform medical insurance reimbursement ratio. After the new regulations are implemented, the medical insurance reimbursement ratio will be adjusted to 80%, and the items covered mainly include hospitalization expenses, outpatient expenses, drug expenses, etc. .Increase hospitalization reimbursement items. After the new regulations are implemented, medical insurance institutions will add large-scale equipment inspections, medical institution management expenses, etc. to hospitalization reimbursement items to better protect patients’ rights and interests in medical treatment.
2. Resettlement and work in another place: it is required to live and work in a different place for more than six months, and registration procedures must be completed in advance;
3. Short-term outings such as business trips, family visits, and tourism Medical expenses: ① Acute diseases: When reimbursing, provide business trip certificates, family visit certificates, outbound travel contracts, real-name air tickets, etc.; ② Outpatient maintenance treatment for chronic diseases: increase the medical records provided for Xiamen outpatient treatment, and the diagnosis and treatment measures during the period away from home cannot exceed the original diagnosis and treatment measures in Xiamen;
4. Delivery in another place: hospital delivery expenses and reasonable prenatal and postpartum examination expenses;
5. If the social security system in local and urbanized areas fails and cannot be settled by credit card in real time: it will be settled by the medical institution Endorsement certificate and seal of the invoice from the charging office;
6. Report loss or damage of social security card, delay in card issuance: Stamp the back of the invoice from the Social Security Card Management Department for confirmation;
7. Outpatient form The number of medical visits per month exceeds 20: the fee bill must be settled by card and show the number of registrations, and outpatient records must be provided;
8. Acute disease or rescue without a social security card: outpatient or inpatient medical records should be recorded in detail and clearly , enough to be considered an acute disease or rescue;
9. Expenses for drugs outside the catalog for retired cadres: the "Approval Form for Drugs Outside the Catalog for Retired Cadres" must be provided and stamped with the official seal of the hospital's medical insurance management department; Health care recipients of retired cadres must provide health care certificates;
10. Insured status, change, change of insured unit, delay in arrival of local tax data: after completing the change procedures at the local tax and confirming the arrival in the middle of the next month Reimbursement can be applied for;
11. Medical expenses for newborns starting from birth: Insurance enrollment and payment should be made in time within three months of birth, and reimbursement can only be made after the payment is received. A birth certificate must be provided; for newborns who are not named when expenses are incurred, the name on medical expense invoices, summary lists, discharge records and other reimbursement documents shall be the mother's or father's name followed by "son" or "daughter".
To sum up, social medical insurance is one of the five major types of insurance, which provides basic protection for the health of the people in our country. If you participate in the basic social medical insurance, you can enjoy the reimbursement of part of the medical expenses.
Legal basis:
Article 28 of the "Social Insurance Law of the People's Republic of China"
Comply with the basic medical insurance drug catalog, diagnosis and treatment items, Standards of medical service facilities and medical expenses for emergency and rescue services shall be paid from the basic medical insurance fund in accordance with national regulations.
Article 29
The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit .
The social insurance administrative department and the health administrative department should establish a medical expense settlement system for medical treatment in other places to facilitate insured persons to enjoy basic medical insurance benefits.