What does the second reimbursement of medical insurance look like?

The second reimbursement of medical insurance is the reimbursement of supplementary medical insurance, but it is not compulsory, and not everyone can make a second reimbursement, only those who participate in the New Rural Cooperative Medical System or urban and rural residents' medical insurance are eligible to use it, and they must meet certain conditions to successfully carry out the second reimbursement.

Many people don't know that medical insurance can be reimbursed twice, how can they enjoy the second reimbursement of medical insurance? First, it must be enrolled in the medical insurance for urban and rural residents, or the rural new rural cooperative medical insurance, and purchased separately.

Second: If the annual expenses exceed the specified amount, you can enjoy a second reimbursement. Third:

When applying for a second reimbursement, you need to bring the case book, the voucher of the first reimbursement, and the discharge certificate.

Did you know that our social security can be reimbursed twice? Most people only know that they use medical insurance for hospitalization, and the rest of the expenses are paid by themselves, in fact, the remaining expenses can be reimbursed twice, regardless of whether you are a resident medical care.

90% of people will ignore the second reimbursement of the social security card, how can it be reimbursed.

What are the conditions for the second reimbursement of medical insurance?

Legal analysis: Medical insurance has a second reimbursement, which can be reimbursed at the hospital or the local social security bureau.

1. NCMS compensation statement;

2. The original household registration and participation card (card) of the resident ID card patient;

3. Invoice for medical institution expenses, or a copy of the official seal of the original collection and storage unit;

4. A copy of the list of expenses, discharge statement or the official seal of the original receiving unit;

5. Hold a chronic disease certificate provided by a patient with a special chronic disease, or a special chronic disease diagnosis certificate and outpatient medical record issued by a medical institution at or above the second level;

6. Bank remittance by the patient himself or a related person with proof of relationship with the patient.

2. Reimbursement process for serious illnesses of NCMS:

1. Immediate settlement upon discharge. NCMS insured persons who seek medical treatment in local second-class hospitals or designated hospitals due to serious illness can directly pay the critical illness insurance compensation funds directly at the hospital charging window, and will be automatically reimbursed according to the proportion of NCMS serious illness insurance when discharged, without the need for additional reimbursement procedures.

2. Settlement after discharge. If the reimbursement settlement is handled after discharge, the procedures are relatively troublesome. After being discharged from the hospital, patients with serious illnesses need to bring their diagnosis certificates, ID cards, original participation certificates and other materials to the NCMS Settlement Department for review.

Legal basis: Article 29 of the Social Insurance Law of the People's Republic of China Article 29 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 institution and the drug business unit. 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.

The second reimbursement, also known as serious illness reimbursement, can be reimbursed again if the conditions for the second reimbursement are met, so as to reduce the burden of family medical expenses.

1. The hospital's serious illness settlement window.

If the hospital is connected nationwide, then when the insured is discharged, he or she can bring relevant information to the hospital's serious illness settlement window and directly use the medical insurance card to reimburse the serious illness expenses.

2. The settlement department of the medical insurance agency.

After the insured person is discharged from the hospital, he or she should go to the local medical insurance agency to apply for reimbursement of serious illness medical expenses with his or her medical insurance card or NCMS medical certificate, ID card of the insured, original voucher of medical expenses, list of expenses, medical certificate, medical record, discharge summary and other certificates.

[Legal basis].

Article 27 of the Regulations on Medical Insurance The personnel of the employer who pays the basic medical insurance premiums in accordance with these Regulations shall enjoy the basic medical insurance benefits.

Article 28 of the Medical Insurance Regulations is used to pay for medical expenses outside the scope of overall payment; If the personal account is insufficient to pay, the person shall be responsible for it.

Article 29 of the Regulations on Medical Insurance The medical expenses for hospitalization for serious illness** shall be paid in the following ways:

1) In principle, the minimum payment standard shall be controlled at 9%-11% of the average annual social wage of employees in cities, counties and autonomous counties in the previous year.

2) In principle, the maximum payment limit shall be controlled at 3-5 times the average annual social wage of employees in cities, counties and autonomous counties in the previous year.

3) Medical expenses above the minimum payment standard and below the maximum payment limit shall be mainly paid by the overall plan, and a certain proportion shall be borne by the individual. Appropriate consideration is given to the proportion of medical expenses borne by retirees.

The scope of serious illness, the specific standard of the minimum payment standard and the maximum payment limit, and the proportion of medical expenses above the minimum payment standard and below the maximum payment limit shall be determined by the provincial people.

The above is only the current information combined with my understanding of the law, please refer to it carefully!

If you still have questions about this issue, it is recommended that you organize the relevant information and communicate with a professional in detail.

What is the secondary reimbursement of medical insurance?Generally speaking, after the first reimbursement, the insured's out-of-pocket payment includes three parts: the hospital threshold fee (different levels of hospitals) + the unfinished part within the scope of medical insurance reimbursement + outside the scope of medical insurance reimbursement (that is, those that cannot be reimbursed). The "second reimbursement of medical insurance" is the second reimbursement of the part that is not covered by the medical insurance reimbursement after the first reimbursement.

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Introduction to "Hospitalization Secondary Medical Insurance":"Second reimbursement" means that residents of urban residents' medical insurance or NCMS can apply for serious illness insurance again in addition to normal reimbursement if they have high expenses for medical treatment in the previous year, and there is no upper limit. Under normal circumstances, the second reimbursement is reimbursed by the citizen's unit.

Coverage: Hospitalization due to illness** (including emergency observation and hospitalization**), outpatient specific items and outpatient chronic diseases**, death or disability due to accidents and burns.

The above is Mr. Li's answer, I hope it can help you.

1. Generally speaking, after the first reimbursement, the part paid by the insured includes three parts: the hospital threshold fee (different levels of hospitals) + the unfinished part within the scope of medical insurance reimbursement + outside the scope of medical insurance reimbursement (that is, those that cannot be reimbursed). The "second reimbursement of medical insurance" is the second reimbursement of the part of the insured that has not been reimbursed within the scope of medical insurance reimbursement after the first reimbursement, and this part of the cost can only be reimbursed if it exceeds 600 yuan.

2. "Second reimbursement" means that residents of urban residents' medical insurance or NCMS can apply for serious illness insurance again in addition to normal reimbursement if they have high expenses for medical treatment last year, and there is no upper limit. Under normal circumstances, the second reimbursement is reimbursed by the citizen's unit.

The second reimbursement of medical insurance means that urban residents went to see a serious illness last year, and the money spent on that illness was a lot and was not reimbursed last year, and this year you can remove the small and medium-sized expenses of last year's major illness, and then reimburse the remaining money once, and the remaining big expenses must be about 50,000 yuan. For example, the reimbursement of expenses exceeding 50,000 yuan accounts for 60%, while the reimbursement of expenses less than 50,000 yuan accounts for 50%.