today's residents' medical insurance settlement. (information film)
from 2015, the medical insurance of urban residents in Ji'nan and the original new rural cooperative medical insurance were merged into "basic medical insurance of Ji'nan residents". After nearly a year's smooth operation, the reporters found that some people still have some specific medical insurance benefits to the residents' health insurance. I know it very well.
How do we calculate the expense of resident medical insurance reimbursement? Can the children of the resident medical insurance be reimbursed? Some diseases need not be hospitalized, but long term medication is needed. With these questions, the reporter visited the Social Security Bureau of Ji'nan, and the staff concerned made detailed answers to the residents' medical insurance benefits that the public was generally concerned about.
how much is the hospitalization fee? This account is very good
"at present, the designated designated medical institution has registered medical insurance card for hospitalization, and there is basically no complicated reimbursement procedure." Ms. Zhu of Ji'nan enjoys the convenience brought by residents' medical insurance.
originally, the residents' medical insurance settlement is very convenient nowadays. "A person only needs to be discharged from the hospital, by the hospital through the medical insurance settlement system to count the expenses of the medical insurance fund in hospital during the hospitalization, and the individual can be relieved to be discharged from the hospital."
the staff of Ji'nan Social Security Bureau, the rest will be settled by the social insurance agency and designated medical institutions in the county (city) district.
for hospitalization expenses reimbursement, different levels of hospital pay standards are also different. In a medical year, the standard of the second hospitalization was reduced by 20%, and the starting standard was no longer implemented from the third hospitalization. The maximum payment limit for residents in a medical year is 200 thousand yuan.
in addition, five patients may apply to establish a family sickbed at the designated community health service institutions or township health centers in their county (city) districts. One is the loss of all or most of the ability of stroke in the brain and the condition of hospitalization; two the advanced action of malignant tumor is difficult; the three is that serious cardiopulmonary disease conforms to the condition of hospitalization, but the hospitalization does have difficulties; four is the fracture traction and fixation of the bed, and five the elderly over 80 years of age should be hospitalized continuously, to the hospital It is difficult to see a doctor.
in addition to hospitalization and encounter "minor ailments", many insured people choose outpatient treatment. The insured can choose a general out-patient designated medical institution after registration and record in the county (city) district. In a medical year, the medical expenses of the insured in the scope of payment in the general out-patient department are burdened by 50% proportions. The maximum annual personal payment limit is 300 yuan (excluding personal burdens).
maternity expenses are also covered by medical insurance reimbursement range
fertility expense is also covered by residents' medical insurance reimbursement. The insured persons who are in compliance with the regulations shall pay quota payment for the birth and medical expenses arising from childbirth. The insured has already received the maternity insurance subsidy for the spouse of the insured male worker, and the residents' basic medical insurance fund will no longer be paid.
the cost of outpatient emergency medical treatment for children due to accidental injuries, over 200 yuan accumulated within the coverage of the resident medical insurance fund, 80% of the residents' medical insurance fund, and the maximum payment limit of 2000 yuan in a medical year (including a certain proportion of a certain proportion of individuals).
the maximum compensation of 300 thousand
each year. In addition, the reporter learned that the residents' medical insurance has increased the treatment of big disease insurance on the basis of the basic medical insurance treatment. In 2015, the policy of large disease insurance stipulated that the medical expenses of the insured person in a medical year and the cost of the outpatient chronic disease included in the payment scope of the fund were included. After the compensation of the basic medical insurance of the residents, the total cost of the cumulative medical expenses of the individual was over 12 thousand yuan, which was compensated by the residents' disease insurance.
in 2015, the standard for the onset and payment of large disease insurance for residents of the whole province was 12 thousand yuan, and the part of the compliance medical cost under the personal burden was not compensated for less than 12 thousand yuan. The personal burden of compliance medical expenses over 12 thousand yuan (12 thousand yuan) and less than 100 thousand yuan was given 50% compensation; 100 thousand yuan (100 thousand yuan) and less than 200 thousand yuan were compensated for 60%; more than 200 thousand yuan (200 thousand yuan) was provided by 65% compensation. In a medical year, the residents' serious illness insurance will give a maximum compensation of 300 thousand yuan per person. (Zhou Guofang)