How to reimburse employee medical insurance for the second time?

In recent years, more and more people have participated in medical insurance in China, and the trade unions have paid employee medical insurance with the unit, and many people are flexibly employed.

They will also pay their own employee medical insurance, and many other people who cannot pay employee medical insurance will also pay resident medical insurance by themselves.

Participating in medical insurance can allow us to obtain medical protection, for example, the insured person can enjoy medical expenses reimbursement when he is sick and hospitalized. If you participate in medical insurance, you will usually participate in critical illness insurance at the same time.

In the case of eligibility, medical insurance reimbursement can be carried out for the second time.

So a friend asked, if the out-of-pocket part is still very high after the first reimbursement, is there an upper limit on the second reimbursement of medical insurance? How much can I be reimbursed?

Employee medical insurance must be paid every month, while resident medical insurance is paid once a year, after enrollment, eligible sick hospitalization expenses can be reimbursed, if the first reimbursement, the remaining part of the self-payment is still unaffordable, can be reimbursed twice in accordance with the regulations.

The second reimbursement will be carried out in accordance with the method of "segmented calculation and cumulative payment", and the reimbursement standard for each region is different, taking Beijing as an example, the reimbursement ratio of the second critical illness insurance within 50,000 yuan (inclusive) is 50%, and the reimbursement ratio of some serious illness insurance above 50,000 yuan is 60%.

Critical illness insurance reimbursement is based on the total cost of medical treatment for the insured person within one year, no matter what disease the insured person suffers from, the cost can be reimbursed according to the corresponding proportion when it reaches a certain amount.

"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.

The second reimbursement of medical insurance refers to the reimbursement of basic medical insurance, and the part of the amount that needs to be paid by the individual will be re-reported by the retirees and military disability subsidies according to the corresponding proportion. In fact, it is the reimbursement of supplementary medical insurance. That is, the hospitalization expenses (including family beds and out-of-town medical treatment) that have been settled within one year, and the part of the self-payment minus the part of category C expenses accumulated throughout the year is more than 10,000 yuan, can enjoy the second subsidy of medical insurance**.

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Hello, there are many conditions that need to be met for the second reimbursement of employee medical insurance. For example, in the case of some major diseases, that is, the insured person of the medical insurance has incurred high medical expenses, and in addition to the normal reimbursement, he can also apply for serious illness insurance again.

Usually the expenses are deducted from the medical insurance personal account and the company's payment, after the first reimbursement, the part borne by the self-payment exceeds the amount stipulated by the local government, and the corresponding certificate and valid certificate of medical expense details can be reimbursed for the second time.

The so-called second reimbursement refers to the same year, the second hospitalization ** for the same disease, the employee medical insurance can be reimbursed, the proportion remains unchanged, the starting line is exempted in some areas, and reduced in some areas.

1. Purchased supplementary medical insurance;

2. The self-paid part exceeds the minimum payment line;

3. The reimbursement items are in the medical insurance catalog;

4. Must be in a designated medical institution for basic medical insurance;

5. The total amount of reimbursement shall not exceed the actual medical expenses.

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Hello, it is a pleasure to serve you. I am the future, a national first-class career counselor, with 1 year of experience in career planning, good at onboarding counseling (resume, interview, background investigation, salary negotiation), career planning, advantage mining, and more than 1,000 hours of 1v1 consulting.

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.

According to the regulations, when the basic medical insurance is used to pay for hospitalization expenses for the first time in a year, the minimum payment amount for incumbents 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. Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide basic medical needs for workers within the scope of protection in case of illness.

The basic medical insurance consists of a co-ordination plan and an individual account. The basic medical insurance premiums paid by individual employees are all included in personal accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is transferred to the personal account, and the other part is used to establish the overall plan**.

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.

Employees' medical insurance can be reinsured. The conditions are: if the personal burden exceeds 600 yuan within the overall plan, the second reimbursement can be handled.

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.

Employee medical insurance cannot be reimbursed twice, and can only be used once.

If the insurance company has its own insurance, it can reimburse the remaining balance.

When receiving the second subsidy, please bring the original and photocopy of the second-generation resident ID card of the person enjoying the second subsidy, and the bank card or passbook of the city (except for the account number of the Rural Commercial Bank); If you do not come to handle it in person, you also need to provide the original and copy of the agent's second-generation resident ID card and go to the Municipal Social Security Center for processing.

Hello, we are Hebei Hukou, Tianjin Tanggu Port Authority employees, have leukemia, and took the medical insurance card during hospitalization, in addition, there is no second reimbursement.

What are the channels through which the second reimbursement of employee medical insurance is obtained?

I am from Heilongjiang, and I have reported 40% of the hospitalization fee in Beijing Hospital for heart bypass in Beijing, can I still be reimbursed twice when I return to the local area?

The second reimbursement of the employee's medical insurance can be reimbursed by the party concerned with his or her ID card, social security card and medical payment documents and other materials to the designated hospital. Medical expenses for the person's second and subsequent hospitalizations. Legal basis:

Article 20 of the Social Insurance Law of the People's Republic of China provides that the treatment standards for 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 in accordance 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 **.