What to do with pharmacy medical insurance, how to use medical insurance card in pharmacies

Shenyang ** pharmacy procedures, municipal medical insurance procedures.

Detailed description The procedures for the transfer of pharmacy, the procedures for the municipal medical insurance, the procedures are complete, and the transfer of the relocation will be completed within ten working days, as long as it is within the jurisdiction of Shenyang.

Contact** 130 Medicine 1931 Room 6776

Apply to the medical insurance center, the medical insurance center will give you the documents and then approve it, and after the approval, you can press the machine

1. When the person holding the medical insurance card sees a doctor in the designated hospital, he can use the medical insurance card directly on the POS machine with the medical insurance card when he is not hospitalized, that is, to pay for diagnosis and treatment, medicine, etc. Note that it should be handled at the designated window of the medical insurance, and the medical insurance card cannot be used to withdraw cash or transfer money.

2. If the medical insurance patient is hospitalized in the designated hospital of the medical insurance, the medical insurance card can be issued, and the unified medical insurance settlement system can read the information of the insured and handle the hospitalization number. The specific reimbursement ratio varies from place to place. Generally, according to the amount of actual expenses, for example, the reimbursement ratio of 10,000 yuan is about 55%-65%.

3. In general medical insurance designated pharmacies, we can use the medical insurance card to pay directly when we buy medicine. However, you must ensure that you have enough money in your health insurance card, and if the money is not enough, you must make up the money yourself.

4. The medical insurance card is real-name for treatment in designated hospitals under medical insurance, so only you can use it, and others cannot borrow it. Similarly, if you use someone else's health insurance card, you can't use it.

5. The new medical insurance card can only be used when the funds are available. Therefore, it is necessary to check the balance of the medical insurance card before using it. The minimum monthly medical insurance card is about 40 yuan, and if you pay higher medical insurance premiums, the more money you will have in the card every month.

Medical insurance can be used at designated pharmacies.

When the basic medical insurance insured person holds the social security card or medical insurance card to settle in the designated retail pharmacy, there is no upper limit on the daily settlement amount of the medical insurance personal account, and the daily cumulative drug purchase amount of the insured person exceeds 500 yuan. The social insurance information system will prompt that after the manager of the designated retail pharmacy or the designated person in charge reviews the identity information of the drug and the person in charge of the drug purchaser, the drug purchaser signs and confirms on the stub on the drug purchase statement, and the designated retail pharmacy retains it for future reference.

Scope of medical insurance reimbursement.

1. The reimbursement of the medical insurance card is limited to the medical expenses above hospitalization caused by illness and some accidents in designated hospitals. The reimbursement formula is: (total cost - threshold fee - out-of-pocket - overrun expenses) * (75 + age *, under normal circumstances, the actual reimbursement ratio varies from 20 to 60%.

Self-financed drugs are not reimbursed, 80% of Class B drugs are reimbursed, there is a limit on bed fees, and some examination fees and diagnosis and treatment fees according to regulations cannot be reimbursed.

2. The reimbursement amount of the medical insurance card is 4 times the average salary of local social workers (the cumulative value within 1 year).

3. The money in the medical insurance card can be used to buy drugs and pay for outpatient and emergency expenses at designated pharmacies, but it does not belong to the reimbursement category, because the money in the medical insurance card is the money in the medical insurance personal account.

4. After the serious illness insurance reimburses the insured person for serious illness, the personal self-responsibility part that occurs in the designated medical institutions of the city's medical insurance and meets the provisions of the city's medical insurance shall be included in the payment scope of the residents' serious illness insurance, and 50% will be reimbursed by the serious illness insurance funds. i.e., reimbursement amount = 50% of the deductible

Legal basis

Social Association Insurance Law of the People's Republic of China

Article 2: The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 25 The State shall establish and improve the basic medical insurance system for urban residents. The basic medical insurance for urban residents implements a combination of individual payment and subsidy. Those who enjoy the minimum living guarantee, the disabled who have lost the ability to work, the elderly over the age of 60 and minors from low-income families, etc., will be subsidized by **.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the state from the basic medical insurance ** payment.

Article 29 The part of the medical expenses of the insured persons that should be paid by the medical insurance shall be settled directly by the social insurance agency and the medical institutions and drug business units.

The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Medical insurance should generally be used by the insured person when he or she is sick and bored, and the insured person can bring his social security card and ID card to the designated medical institution, pharmacy, or local social security agency for direct settlement. For medical expenses within the scope of the basic medical insurance drug list, you can apply for reimbursement in accordance with the law.

Article 28 of the Social Insurance Law of the People's Republic of China in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and medical expenses for emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations. Article 29 of the Social Insurance Law of the People's Republic of China The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institutions and drug business units. The social insurance administrative department and the Ministry of Health Administration shall establish a system for settling medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.