How to report the second reimbursement of medical treatment? What should I pay attention to?

Secondary reimbursementFirst of all, it should be passedBasic medical insuranceReimbursement is made for items other than those involved. Supplemental medical insurance.

Valid for one year. In the fiscal year following discharge.

During the accounting period, patients should pay attention to the validity period and not miss the opportunity for a second reimbursement. As for the proportion and standard of reimbursement, it varies according to the item, category and variety of drugs used by the patient. And the hospital level is different.

There are factors such as differences between special patients and ordinary patients. There will be no "one-size-fits-all" standard or absolute "average" to consider. But it should be believed that the impartiality under the "computer template" is very high.

And then there's the appearanceCritical illness medical insuranceHigh costs aimed at ** serious illness, tooCancerThe main channel for secondary reimbursement. Serious illness here does not specifically refer to diseases such as cancer. It is considered a serious illness as long as there are high medical expenses due to a disease covered by domestic medical insurance.

Policies vary from place to place, and there is no unified classification of "serious diseases" across the country, but in general, there are still two ways to define the scope of reimbursement.

It should be noted that there are basic conditions for serious illness medical insurance, which is specially reimbursed for serious illness. Critical illness medical insurance and critical illness assistance are two different things. Note that serious illness here does not specifically refer to major diseases such as cancer or heart disease.

When the illness within the scope of the resident's reimbursement reaches a certain high cost, it can be recognized as a serious illness. During the one-year cycle, the insured person will be reimbursed for the total cost of medical treatment. If the cost exceeds a certain amount, regardless of the illness of the insured person, it can be reimbursed in two proportional installments.

You must know that when we buy drugs in the hospital, some drugs that are covered by reimbursement can be reimbursed through medical insurance. It's just that the reimbursement rates are different for different drugs. Some of our widely used and relatively inexpensive drugs are fully reimbursable.

There is also a more expensive and less commonly used prorated reimbursement. In addition, the money spent during hospitalization can also be reimbursed, which requires us to pay attention to the conditions of reimbursement in order to be better reimbursed.

If the insured employee incurs medical expenses in the field on a business trip or visiting relatives, only the emergency expenses in the field that meet the provisions of the medical insurance will be reimbursed, and all expenses will not be reimbursed for hospitalization for non-emergency reasons. If the insured employee has lived in other places for more than 6 months, the medical expenses will be reimbursed according to the nature of long-term residents. Long-term residents of non-local personnel should be provided by the unit to provide certificates, determine two designated hospitals (should be designated medical institutions for local medical insurance), and timely apply for the "Zhenjiang Mayor Resident Non-local Employees Medical Expense Reimbursement Card".

The second reimbursement of medical treatment needs to be reimbursed at the settlement window of the hospital or the medical insurance bureau, and you can provide some of your hospitalization lists, and you need to pay attention to bring your medical insurance card.

You can first make a summary of all your expenses, and then take these expenses to the local medical insurance center for reimbursement. Pay attention to your own expenses, but also pay attention to the cost of reimbursement, also pay attention to the proportion of reimbursement, also pay attention to some problems encountered in the reimbursement process, and also pay attention to the amount spent.

There is a certain proportion of secondary reimbursement for medical treatment, and the reimbursement ratio is different in each region, and in some areas, individuals can apply for secondary reimbursement if they spend more than 10,000 yuan.

The second reimbursement means that residents of urban residents' medical insurance or NCMS can apply for serious illness insurance again in addition to the normal reimbursement if they have high expenses for medical treatment last year, and there is no upper limit.

Procedures for secondary reimbursement:

1. ID card or household registration book of inpatients participating in social security; The main thing is the patient's own valid document.

2. Participate in the cooperative medical certificate of social security inpatients;

3. Discharge certificate;

4. Receipts for medical expenses;

5. Detailed list of hospitalization expenses;

6. Other materials required to be submitted by the county and urban cooperative medical management agencies.

Secondary Reimbursement Process:

1. The application shall be submitted to the local county and city cooperative medical management agency for processing, and then the institution shall accept and review it.

2. The acceptance agency is generally handled by the local medical insurance center.

3. Application result: After the material application is submitted, there will be relevant application results after a period of time, and the handling agency will inform the individual of the handling situation.

4. Cost accounting, after the application is approved, the relevant institutions will calculate the cost in accordance with the policy.

5, the second reimbursement of the cost of the application conditions in the city's basic medical insurance designated medical institutions, in line with the city's urban and rural residents basic medical insurance reimbursement scope of the expenses, after the basic medical insurance reimbursement, urban residents within the scope of the basic medical insurance policy personally pay more than the previous year's urban residents annual per capita disposable income of the city.

Within the scope of the basic medical insurance policy, rural residents who pay more than the annual per capita net income of rural residents in the city in the previous year (hereinafter referred to as the "minimum payment amount") shall be included in the scope of payment of the city's urban and rural residents' serious illness insurance and will be reimbursed for the second time.

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

Answer: Expenses with a total amount of more than 10,000 yuan will be paid by the critical illness insurance for another 95%. All insured persons who participate in the city's employee medical insurance and resident medical insurance, who meet the above provisions, can apply for secondary compensation for serious illness at the local social security bureau's human health insurance acceptance point. If the insured person is unable to handle it in person, he or she can be handled by the guardian or immediate family member, and only need to provide the identity certificate (or household registration book), proof of relationship with the principal, bank account number and power of attorney.

Most people don't know that medical insurance can be reimbursed, and more than 50% are still in the dark.

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.

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

Reimbursement Method.

The minimum payment amount is quoted at 50% or 60%.

How to be reimbursed by critical illness insurance is the most concerned issue for patients.

First of all, the critical illness insurance is not reimbursed according to the type of disease, but according to the total cost of the person's medical treatment within one year, and the expenses exceed a certain amount, no matter what disease the insured suffers from, it can be reimbursed according to the corresponding proportion.

After the residents who have participated in the urban residents' medical insurance are reimbursed by the normal medical insurance, the remaining personal out-of-pocket expenses within the scope of medical insurance reimbursement can be reimbursed if they exceed the annual per capita disposable income of urban residents in the city in the previous year (referred to as the minimum payment amount). If the excess is less than 50,000 yuan, 50% will be reimbursed by the critical illness insurance fund; Expenses exceeding 50,000 yuan will be reimbursed by 60% of the critical illness insurance funds.

However, the minimum payment amount of NCMS is the annual per capita net income of rural residents in the city in the previous year, and the excess personal self-payment is included in the scope of reimbursement.

Billed once a year for medical insurance. Since the annual per capita disposable income of urban residents and the annual per capita net income of rural residents in 2013 have not yet been counted, the specific reimbursement work has not yet begun.

The second reimbursement is limited to NCMS, and reimbursement can be made at the hospital window or the NCMS Settlement Department.

1. NCMS secondary reimbursement process.

1) Instant settlement.

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, you need to bring the relevant materials to the NCMS Settlement Department for review after discharge, and those who meet the conditions can get the NCMS compensation, and those who do not meet the conditions will be reimbursed according to the general hospitalization reimbursement ratio.

2. Materials required for the second reimbursement of NCMS.

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 unit;

4) A copy of the list of expenses, discharge statement or the official seal of the original collection 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) The bank remittance account of the patient himself or a related person who has proof of relationship with the patient.

Hope it helps you and I wish you happiness and happiness every day! 欄欄

Hope it helps you and I wish you happiness and happiness every day! 欄欄

1. The reimbursement of outpatient and emergency expenses is 2,000 yuan for in-service employees and 1,300 yuan for retirees. If the accumulated outpatient and emergency expenses within a year are less than 2,000 yuan for employees and less than 1,300 yuan for retirees, they shall be paid by the insured from their personal accounts. If the amount above the threshold is reached within a calendar year, the Large-Amount Mutual Medical Aid System can be applied.

2. Reimbursement of hospitalization expenses According to the regulations, when the basic medical insurance is used to pay for hospitalization expenses for the first time in a year, the starting amount of in-service and retirees is 1,300 yuan. For the second and subsequent hospitalizations, the minimum payment standard is determined at 50% and is 650 yuan. The maximum payment of basic medical insurance pooling** (hospitalization expenses) in a year is currently 70,000 yuan.

The individual contribution rate for retirees is 60% of the individual contribution rate for active employees, but the part below the threshold is the same, and all payments are made by individuals. The standard of reimbursement for hospitalization is related to the level of the medical institution where the insured person lives. Note:

Outpatient and inpatient are two minimum payment lines.

3. How much does it cost to pay more than the maximum payment limit? If the hospitalization expenses of the insured person exceed the maximum payment limit, the excess expenses will be reimbursed according to the relevant standards of large-amount mutual medical assistance, that is, 70% will be paid by the large-amount mutual medical assistance fund and 30% will be paid by the individual. Within one year, the cumulative maximum amount of payment for large-scale mutual medical assistance is 100,000 yuan.

To sum up, how to stipulate the second reimbursement of medical insurance, the starting line of medical reimbursement for social security personnel, within the year of in-service employees, the first reimbursement starting point is 1,300 yuan, the second starting payment standard is 50% of the first standard, that is, 650 yuan is the reimbursement starting line, the payment ratio of retirees is 60% of the in-service personnel, and the hospitalization reimbursement standard is related to the medical institution where the insured person is located.

For users who pay medical insurance, the second reimbursement is a major benefit of the state to the people. Although many users do not know that medical insurance can be reimbursed, patients who pay medical insurance according to regulations are eligible for this benefit. It's just that the specific proportion of the second reimbursement, the amount and other regulations are not uniform.

So, how to report the second reimbursement of medical insurance?

Medical expenses that exceed the maximum payment limit of the basic medical insurance pool**.

80% of the subsidy for residents and students and children in the first grade, and 70% for residents in the second tier. 90% subsidy for employees, with a maximum subsidy of 400,000 yuan in one year.

The part that exceeds the threshold of critical illness medical insurance in a year.

60% of the subsidy for students and children; 50% subsidy for residents in the second tranche. 75% of the employee subsidy, with a maximum payment of 200,000 yuan in one year.

For the second reimbursement of serious illness medical insurance, there is no need for individuals to take the initiative to provide materials for settlement. When the accumulated hospitalization expenses reach a certain amount, the hospital will automatically initiate the second reimbursement settlement.

To put it simply, the second reimbursement of medical insurance is settled on an annual basis, and if the part paid out of pocket reaches the starting line, it can be settled directly at the hospital settlement window. After being discharged from the hospital, bring your medical insurance card, hospitalization bills, etc., to the local medical insurance agency for serious illness insurance reimbursement.

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

What are the conditions for the second reimbursement?

If you reach a certain standard of medical expenses, you can make a second reimbursement, so what specific conditions need to be met before the second reimbursement, there are three points here.

Clause. 1. Must be an insured resident.

The second reimbursement is after the first reimbursement anyway, because it must be an insured resident before the second reimbursement can be made. If you're not even insured, then it's all empty talk. According to China's current medical insurance coverage, the vast majority of people are insured.

Clause. Second, the cost is still very much after a reimbursement.

Normally, after a certain percentage of the first reimbursement after the medical treatment, the remaining expenses are basically not too much. However, if the remaining medical expenses to be paid by the individual after the first reimbursement exceed the per capita annual income level of the local urban or rural residents, then you can apply for a second reimbursement.

Within the scope of the basic medical insurance policy, the expenses paid by rural residents in excess of the annual per capita net income of rural residents in the previous year (hereinafter referred to as the "minimum payment amount") shall be included in the payment scope of the serious illness insurance for urban and rural residents, and the "secondary reimbursement" will be carried out.

The expenses incurred in the designated medical institutions of basic medical insurance and in line with the reimbursement scope of basic medical insurance for urban and rural residents, after the reimbursement of basic medical insurance, urban residents within the scope of the basic medical insurance policy pay more than the annual per capita disposable income of urban residents in the previous year, and the question is not understood.

After the reimbursement of basic medical insurance, urban residents within the scope of the basic medical insurance policy pay more than the annual per capita disposable income of urban residents in the previous year, and rural residents within the scope of the basic medical insurance policy pay more than the annual per capita net income of rural residents in the previous year (hereinafter referred to as the "minimum amount"), included in the scope of urban and rural residents' serious illness insurance payment, carried out" Secondary Reimbursement".

Expenses paid by individuals in excess of the annual per capita net income of rural residents in the previous year (hereinafter referred to as the "minimum payment amount") shall be included in the scope of payment by the serious illness insurance for urban and rural residents, and shall be subject to "secondary reimbursement".