How is the second reimbursement of medical insurance calculated?

The second reimbursement of medical insurance can be reimbursed by the parties concerned with their ID cards, social security cards, medical payment documents and other materials to the designated hospitals. According to the provisions of the social insurance system, within one year, the first reimbursement, the starting amount is 1,300 yuan, the second time according to the first 50% of the standard to determine, within one year, the maximum payment limit of medical insurance is 70,000 yuan, the initial reimbursement line for emergency reimbursement is 2,000 yuan, and the retired employee is 1,300 yuan, the starting line.

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

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.

2. The cost is still very high 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.

How much can I reimburse for the second reimbursement of medical insurance?

The higher the level, the lower the reimbursement ratio, the lower the reimbursement ratio, such as the reimbursement ratio of community medical insurance is generally 35%-45%, and the specific amount has to be combined with local rules, and there may be differences in different regions.

Therefore, the reimbursement ratio should be based on local rules, and the reimbursement ratio is different in different regions. Taking Beijing as an example, the reimbursement ratio of secondary critical illness insurance for expenses within 50,000 yuan (inclusive) is 50%, and the reimbursement ratio of some serious illness insurance for expenses above 50,000 yuan is 60%.

Legal basis

Article 26 of the Social Insurance Law of the People's Republic of China.

The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations.

Article 28 of the Social Insurance Law of the People's Republic of China.

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses 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 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.

If you are participating in the medical insurance for urban and rural residents, including the second reimbursement of the New Rural Cooperative Medical Insurance, you have achieved comprehensive coverage. You can apply as soon as your out-of-pocket expenses exceed the starting threshold. If you are an insured person of employee medical insurance, many places have also launched a secondary reimbursement policy for urban employees.

The second reimbursement of medical insurance generally refers to the reimbursement of critical illness insurance.

In most cases, in the process of local hospitalization with a social security card**, after the settlement bill shows that the self-payment part of the individual exceeds a certain amount, it will automatically enter the scope of serious illness reimbursement and be directly settled after discharge, and only need to bear the part that the insured needs to bear.

However, if the insured patient is referred to a foreign place for hospitalization, it is likely that after the out-of-pocket payment exceeds a certain amount, he or she will need to return to the insured place with the relevant settlement receipts for cash reimbursement.

With the continuous development of medical insurance informatization, more and more application scenarios can automatically trigger the secondary reimbursement of medical insurance through the system, and patients are rarely required to run away to the agency for cash reimbursement.

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In general, one of the most common factors for secondary reimbursement is a serious illness, which can be reimbursed.

Because we all know that in the process of paying medical insurance premiums every year, in addition to the most basic monthly expenses, in fact, you need to pay about dozens of yuan for serious illness medical expenses once a year.

The cost of serious illness medical insurance in my area is 40 yuan per year, but we must not underestimate this 40 yuan, because it can play a decisive role in the critical moment, and the serious illness medical insurance in my area.

This has reduced a lot of financial burden and pressure for many of us in the process of seeing a doctor, after all, enjoy a second reimbursement, then the remaining part of us has not been reimbursed, in fact, we can carry out the second....

In fact, in addition to the secondary reimbursement of serious illness medical insurance, there is also a situation, and the vast majority of people do not know much about this situation, which is aimed at some groups of people with minimum living security, which can be reimbursed twice.

As long as the medical insurance insured person has made normal medical insurance reimbursement, if the remaining self-paid medical expenses have exceeded the disposable income of the city's urban residents in the previous year, the excess part can be reimbursed for a certain proportion. For example, the reimbursement of less than 50,000 yuan is generally by serious illness insurance.

50% of the funds will be reimbursed, and if it has exceeded 50,000 yuan, then 60% will be reimbursed. Of course, this is just a metaphor, and the local reimbursement amount still needs to be consulted by the local agency.

And if you are not a townsman, but NCMS.

The amount of your reimbursement is calculated according to the per capita net income of rural residents in the city, and the amount of excess personal self-payment is also reimbursed according to a certain percentage, which is different in each place and needs to be checked by yourself.

So, if you have a major illness in your family.

And if you have spent a lot of money, it is recommended that you go to the local area for reimbursement consultation, after all, medical insurance can only be reimbursed once, and many major diseases can be reimbursed for a second time after spending too much.

Target. Extended Resources:

Medical insurance, in the traditional or prescribed sense, refers to the management of a specific organization or institution, through the enforcement of the belt.

Policies and regulations or voluntary contracts to raise medical insurance among a certain number of insured people in a certain area**.

Medicare originated in Western Europe and can be traced back to the Middle Ages. With the bourgeois revolution.

The success of the family workshop was replaced by large industry, and the modern industrial contingent appeared. Due to the harsh working environment, diseases and industrial accidents are prevalent.

The occurrence of workers makes them demand medical attention accordingly. However, their wages are low, making it difficult for individuals to pay for medical expenses. As a result, workers in many places organized themselves to raise a part of the money to cover expenses in case of illness.

But this form is not very stable, and it is small-scale, and the ability to resist risks is very low. At the end of the 18th century and the beginning of the 19th century, private insurance developed in Western Europe and became an important way for the state to raise medical funds.

Medicare has social insurance.

The basic characteristics of compulsion, mutual aid, and sociality. Therefore, the medical insurance system is usually enforced by the national legislation, and the establishment of a first-class system, the cost is jointly paid by the employer and the individual person, and the medical insurance premium is paid by the medical insurance institution to solve the medical risk caused by the illness or injury of the worker.