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

If the insured wants to enjoy the treatment of secondary reimbursement, he or she needs to meet two conditions:The first is to pay the medical insurance fees on time, and the second is that the amount of personal self-payment has reached the threshold of the second reimbursement.

Under normal circumstances, our medical expenses are relatively small, and the reimbursement of medical expenses can be completed through medical insurance, and there is no need for secondary reimbursement, but if we have an accident or a serious illness, then the medical expenses may be more, even after the medical insurance reimbursement, the personal need to bear more expenses, then you can apply for a second reimbursement.

When applying for a second reimbursement, we need to pay the amount out of our own pocketExceeding the local threshold for secondary reimbursementFor example, the starting line for secondary reimbursement in some areas is a fixed amount, and the starting line for secondary reimbursement in some areas is calculated according to the local per capita consumption level.

Assuming that the starting line of the second reimbursement is 30,000 yuan, the reimbursement ratio within 60,000 yuan is 70%, and the reimbursement ratio above 60,000 yuan is 80%.How is the amount of the second reimbursement calculatedThis?

For example, Aunt Wang spent 250,000 yuan on hospitalization, and after the medical insurance reimbursement, the amount of self-payment that the individual needs to pay is 110,000 yuan, then the self-payment amount of 110,000 yuan exceeds the starting line of the second reimbursement, so the 110,000 yuan can apply for the second reimbursement.

At the time of reimbursement, first remove the minimum payment amount of 30,000 yuan, and the amount that Aunt Wang can still participate in the reimbursement is 80,000 yuan, of which 60,000 yuan is reimbursed according to the proportion of 70%, the reimbursement amount is 10,000 yuan, and the amount exceeding 60,000 yuan is reimbursed according to the proportion of 80%, that is, 20,000 yuan * 80% = 16,000 yuan.

After the second reimbursement, Aunt Wang needs to pay only 10,000 yuan out of pocket, saving a lot of medical expenses, so the protection enjoyed by paying medical insurance is still relatively large.

Conditions for the second reimbursement of medical insurance:

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.

Information required for the second reimbursement of critical illness medical insurance:

When receiving the second subsidy, the original and photocopy of the second-generation resident ID card of the person enjoying the second subsidy, the bank card or passbook of the city (except for the Rural Commercial Bank) shall be held; If you do not come in person, you must also provide the original and copy of the agent's second-generation resident ID card.

Reimbursement Amount:

Segmented calculation, cumulative payment". Expenses incurred in the designated medical institutions of basic medical insurance in Beijing with a "minimum payment amount" of more than 50,000 yuan (inclusive) shall be reimbursed by 50% of the serious illness insurance funds; Expenses exceeding 50,000 yuan will be reimbursed by 60% of the critical illness insurance funds.

Two conditions need to be met, one is to participate in basic medical insurance, and the other is that the personal out-of-pocket amount exceeds the threshold for secondary reimbursement. How much you can be reimbursed varies from place to place.

What is Medicare Secondary Reimbursement?

Can medical insurance be reimbursed twice? Many people have not heard of this thing, and it is foggy. In fact, the secondary reimbursement of medical insurance does exist.

To put it simply, if the insured person unfortunately suffers from a serious illness and incurs high medical expenses, and the expenses paid by the individual exceed the prescribed threshold, they can be reimbursed twice, which is actually the second reimbursement of the serious illness insurance, and the main purpose is to reduce the burden of serious illness.

Need to be eligible?

In order to enjoy the secondary insurance of medical insurance, two conditions must be met:

First, you must participate in the basic medical insurance, and you can enjoy the second reimbursement if you participate in the employee medical insurance or the urban and rural residents' medical insurance, but the starting line of the second reimbursement of the two is different.

Second, the out-of-pocket expenses of the individual must exceed the threshold of the second reimbursement of medical insurance. If you do not reach the minimum payment line, you cannot enjoy the second reimbursement of medical insurance.

How much can I be reimbursed?

If the conditions for the second reimbursement of medical insurance are met, how much can be reimbursed? This mainly depends on the starting line of the secondary reimbursement and the level of the reimbursement ratio in various places.

For example, the threshold for reimbursement of serious illness for urban workers in Beijing is 39,525 yuan, and the threshold for reimbursement for serious illness of urban and rural residents is 30,404 yuan. The reimbursement ratio is 60% within 50,000 yuan for the part above the threshold standard, and 70% for more than 50,000 yuan, with no upper limit.

For example, Lao Liu, an enterprise worker in Beijing, is usually busy with work, but he becomes ill from overwork, unfortunately suffers from a serious illness, and after medical insurance reimbursement, as well as after deducting the unit's supplementary medical insurance and medical assistance, he has to pay 300,000 yuan by himself, so how much can he be reimbursed for the second reimbursement?

Participating in the medical insurance for urban employees, therefore, the amount that can be used for the second reimbursement is 300,000 yuan - 39,525 yuan = 260475 yuan for the second reimbursement line for urban employees.

More than 50,000 yuan, so it needs to be reimbursed in sections, the reimbursement amount of the part within 50,000 yuan is 50,000 60% = 30,000 yuan, and the part above 50,000 yuan can be reimbursed (260475 yuan - 50,000) 70% = yuan. Therefore, a total of 30,000 + yuan = yuan was reimbursed twice.

Originally, individuals needed to pay 300,000 yuan out of their own pockets, but they were reimbursed more than 170,000 yuan for the second time, which shows that the reimbursement for serious illnesses is still very powerful.

How to reimburse for the second reimbursement?

The second reimbursement of medical insurance is once a year, and the reimbursement of the previous year's serious illness medical insurance expenses in the following year. In the application procedure, there is no need for differential personnel to run errands to apply, no need to declare, and the qualified system is automatically reimbursed and paid by the system, which is also very humane, saving the trouble of reimbursement for insured personnel. Kudos!

Therefore, in order to enjoy the second reimbursement, it depends on whether you meet the conditions of insurance and the starting line, and if you do not meet the conditions, there will be no second reimbursement.

Hello! The second reimbursement of medical insurance needs to meet the following conditions: 1. People who have purchased supplementary medical insurance 2. The self-paid part after medical insurance reimbursement exceeds the starting line 3. A large number of documents need to be prepared, such as payment invoices, prescriptions, inspection sheets and ** singles, etc. 4. The items in the medical insurance catalog, drugs and ** items outside the catalog cannot be reimbursed 5, and they must be treated in designated hospitals 6. The total reimbursement of medical insurance reimbursement and supplementary medical insurance reimbursement cannot exceed the actual medical expenses.

Hello! The first page of the medical record is the first page of the medical record.

Ask a good question, thank you.

All kinds of inspection reports.

Hello! The first page of various inspection reports.

If you want to make a second reimbursement, you need to meet certain conditions, here take urban and rural residents' medical insurance as an example, you usually need to meet the following conditions: people who are normally insured and have not paid medical insurance fees cannot be reimbursed through medical insurance. Secondly, after the first reimbursement, the remaining expenses exceed the average annual income of the local area in the previous year.

Extended Materials. 1. We all know that medical insurance hospitalization can be reimbursed, but some friends are not very clear about the second reimbursement. The so-called second reimbursement refers to the fact that when residents incur huge medical expenses through urban residents' medical insurance or new rural cooperative medical care, in addition to the first reimbursement, eligible people can be reimbursed for the second time.

In this way, in the end, the individual payment will be much lower. Under normal circumstances, a second reimbursement would only be made if the medical expenses exceeded a certain standard, which would lead to poverty due to illness.

2. Specific conditions for the second reimbursement: Since the second reimbursement can be made after reaching a certain standard of medical expenses, what specific conditions need to be met for the second reimbursement: There are three points here. It must be an insured resident.

3. The second reimbursement is after the first reimbursement in any case, because the second reimbursement can only be made if the insured resident is determined. If you don't have insurance, then everything is empty talk. According to China's current medical insurance system, the vast majority of people have medical insurance.

4. After the first reimbursement, the cost is still very high. Normally, after seeing a doctor, after reimbursing a certain percentage first, the remaining expenses are basically not too much. However, if after the first reimbursement, the remaining medical expenses paid by the individual exceed the per capita annual income level of the local urban or rural residents, they can apply for a second reimbursement.

5. All kinds of hospital bills should be prepared. Due to the need for a second reimbursement, various hospital bills and proofs need to be prepared. After all, if the supporting documents are incomplete, it is naturally difficult to confirm the reimbursement, and in some places even a special seal is required.

6. Of course, it is not excluded that some fields with more advanced computerization can be automatically reimbursed. Finally, the medical expenses you need to pay are the expenses after the second reimbursement. Finally, it should be noted that although the second reimbursement can be carried out in accordance with the regulations, the standards are different in different places, so it is important to have a clear understanding of the local policies before the second reimbursement.

Requirements: Hospitalization certificate, special diseases. The conditions for the second reimbursement of NCMS are as follows:

1. Participated in the New Rural Cooperative Medical System of that year. 2. In that year, there was a large balance of NCMS, and the local government issued a secondary reporting policy, and the document was generally issued at the beginning of the second year. 3. If the medical expenses meet the minimum payment standard, (the specific amount depends on the requirements of local documents), the compliant medical expenses borne by individuals above the minimum payment standard will generally be reimbursed in different grades.

4. Theoretically, it must be a one-time medical expense to reach the minimum payment line, and multiple medical treatments cannot be combined into one time. Congenital heart disease, childhood leukemia, cervical cancer, breast cancer, cleft lip and palate, end-stage renal disease, severe mental illness, tuberculosis, AIDS, colon cancer, gastric cancer, hemophilia, chronic myeloid leukemia, more than 20 kinds of diseases, friends who have participated in NCMS can enjoy the second reimbursement policy.

Legal Analysis: 1. Identity Requirements.

Residents must participate in the medical insurance for urban and rural residents or participate in the "New Rural Cooperative Medical System", and purchase it separately, and the status at this time can be "reimbursed" for medical insurance.

2. Overhead conditions.

After the residents use the basic medical insurance reimbursement in the previous year, the urban residents within the scope of the basic medical insurance policy pay more than the annual per capita disposable income of urban residents in Beijing City, and the rural residents within the scope of the basic medical insurance policy, the individual pays more than the annual per capita net income of rural residents in Beijing in the previous year, and the first expense condition at this time is the "second reimbursement" of medical insurance.

3. Material conditions.

When making a "second reimbursement", residents need to prepare the required patient medical records, ID cards, discharge certificates, the first summary reimbursement form and other materials in advance (due to different administrative regions, the detailed list of documents and materials required for the "second reimbursement" may be slightly different, please consult the local reimbursement unit). At this time, the preparation of materials can be carried out for the "second reimbursement" of medical insurance.

Legal basis: Social Insurance Law of the People's Republic of China Article 16 Individuals who participate in basic old-age insurance and have paid contributions for 15 years when they reach the statutory retirement age shall receive a basic pension on a monthly basis.

Individuals who participate in the basic endowment insurance and have paid contributions for less than 15 years when they reach the statutory retirement age can pay for 15 years and receive the basic pension on a monthly basis; It can also be transferred to the new rural social endowment insurance or urban residents' social endowment insurance, and enjoy the corresponding endowment insurance benefits in accordance with the regulations.

1. Identity conditions. Residents must participate in the medical insurance for urban and rural residents or participate in the "New Rural Cooperative Medical System", and purchase it separately, and the status at this time can be "reimbursed" for medical insurance.

2. Overhead conditions. After the residents use the basic medical insurance reimbursement in the previous year, the urban residents in the basic medical insurance policy within the scope of the individual pay more than the previous year's urban residents in the previous year's per capita disposable income, rural residents within the scope of the basic medical insurance policy, the individual pays more than the previous year's rural residents in Beijing rural residents annual per capita net income, at this time, the first expense conditions can be carried out for the medical insurance "secondary reimbursement".

3. Material conditions. When making a "second reimbursement", residents need to prepare the required patient medical records, ID cards, discharge certificates, first reimbursement forms and other materials in advance (due to different administrative regions of Senmai Sakura, the list of detailed documents and materials required for "second reimbursement" may be slightly different, you can consult the local reimbursement unit). At this time, the preparation of materials can be carried out for the "second reimbursement" of medical insurance.

There are two conditions for the second reimbursement, one is to pay basic medical insurance; Second, the personal out-of-pocket expenses meet the minimum payment standard for Yinnian serious illness reimbursement. The information required for the second reimbursement of medical insurance is as follows: 1. When receiving the second subsidy, the original and photocopy of the second-generation resident ID card of the person enjoying the second subsidy, and his bank card or passbook (except for rural commercial banks); If you do not come in person, you must also provide the original and copy of the agent's second-generation resident ID card.

2. Reimbursement amount: "segmented calculation, cumulative payment"; 3. Reimbursement method: 50% or 60% of the minimum payment amount is reported firstly, the critical illness insurance is not reimbursed according to the type of disease, but according to the total cost of medical treatment within one year, and the cost exceeds a certain amount, no matter what disease the insured suffers from, it can be reimbursed according to the corresponding proportion.

4. 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 the annual per capita disposable income of urban residents in the city in the previous year (referred to as the minimum payment amount) is exceeded. 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.