Is it reimbursed for resident medical insurance for hospitalization for the same disease twice in a

It can be insured in the following ways:

Taking Xuzhou City as an example, the medical insurance for employees in Xuzhou urban area and the medical insurance for residents in Xuzhou urban area who normally participate in insurance and pay premiums.

All hospitalization expenses (including family beds and out-of-town medical treatment) that have been settled during the period from January 1, 2012 to December 31, 2012, 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 2012 medical insurance in Xuzhou City**.

of secondary grants.

Subsidy ratio: the amount that meets the scope of the subsidy: 60% subsidy for 10,000 to 50,000 yuan; 70% subsidy for 50,000 to 100,000 yuan; 80% subsidy for more than 100,000 yuan; If those who are also entitled to severe disability, extreme poverty, and subsistence allowance benefits will be increased by 10%.

Required materials: When receiving the second subsidy, please bring the second-generation resident ID card of the person enjoying the second subsidy, and his or her 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.

Prepare the above materials to the Municipal Medical Insurance Center (No. 181 Huaihai West Road) service hall on the second floor of No. 19, No. 20 window for application procedures, the Municipal Medical Insurance Center temporarily issued in 2012 is the second subsidy for urban employees and residents of the medical insurance, there is no time limit for the application procedures, and normal working days can be handled.

Diseases that are covered by medical insurance can be reimbursed, as long as you are not directly admitted to the hospital and then hospitalized on the day you are discharged from the same hospital, you can be reimbursed.

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 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.

"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**.

Medical Insurance Secondary Reimbursement Process:

1. Reimbursement of outpatient and emergency expenses.

The minimum payment amount for large-amount medical mutual aid (outpatient and emergency) 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 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.

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.

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The NCMS medical insurance reported that the second starting line was halved within one year. NCMS can be reimbursed on New Year's Eve, generally within 3 months of hospitalization, and there is a minimum payment line for the second hospitalization within one year.

The deduction method of the minimum payment line may vary from place to place, but most provinces, cities and counties stipulate that the minimum payment line will be reduced by half for the second time in the same year, the same disease type, and the second hospitalization in the same medical institution.

Of course, some people may wonder if my third hospitalization is reduced by half on the basis of the second hospitalization, which is impossible, and the second and third hospitalizations this year are reduced by half on the basis of the first hospitalization. If the doctor recommends a referral to a higher-level medical institution for hospitalization due to limited conditions in the medical institution where you live, the hospitalization in the higher-level medical institution will no longer deduct the minimum payment line, of course, some areas may be different, such as only the first item is implemented, and the second item is not implemented. The township-level starting line is generally 100-200 yuan.

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From a legal point of view, if the interval between the two admissions is not more than 15 days, then the second admission cannot be reimbursed. The insured person can be hospitalized again in a short period of time after being hospitalized due to **, and for the re-hospitalization in a short period of time due to **, the insured person shall provide relevant certificates for hospitalization registration.

Can medical insurance reimburse hospitalization for two hospitalizations for different illnesses within a month?

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From a legal point of view, if the interval between the two admissions is not more than 15 days, then the second admission cannot be reimbursed by the medical and departmental insurance. The insured person Yan Bu can be hospitalized again in a short period of time after he needs to be hospitalized, and for the re-hospitalization in a short period of time after the accident, the insured person shall provide relevant certificates for hospitalization registration.

Legal basis: Article 2 of the Social Insurance Law of the People's Republic of China stipulates that the State shall establish a basic social insurance system such as endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, so as to protect citizens' right to receive material assistance from the state and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc. Article 26 The standards for the treatment of basic medical insurance for workers, the new type of rural cooperative medical care, and the medical and filial piety insurance for urban residents shall be implemented in accordance with state regulations.

Legal analysis: In the case of social security, the medical expenses incurred in multiple contributions or hospitalizations in a year can be reimbursed in accordance with the local medical insurance policies as long as they are within the scope of medical insurance.

Legal basis: Social Insurance Law of the People's Republic of China

Article 23 Employees shall participate in the basic medical insurance for employees, and the employer and the employees shall jointly pay the basic medical insurance premiums in accordance with the provisions of the State. Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

Article 2: The State shall establish and improve a new type of rural cooperative medical system. The management measures for the new type of rural cooperative medical care shall be stipulated by ***.

Article 25 The State shall establish and improve the basic medical insurance system for urban residents. The basic medical insurance for urban residents implements a combination of individual payment and subsidy. Those who enjoy the minimum living guarantee, the disabled who have lost the ability to work, the elderly over the age of 60 and minors from low-income families, etc., will be subsidized by **.

Article 26 The treatment standards of basic medical insurance for employees, new rural medical treatment and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 27 Individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, the cumulative contributions reach the number of years prescribed by the State, and they will no longer pay the basic medical insurance premiums after retirement, and enjoy the basic medical insurance benefits in accordance with the provisions of the State; If the number of years prescribed by the state has not been reached, the fee can be paid until the number of years prescribed by the state.

Legal analysis: The medical insurance card does not stipulate how many times a year to stay in the hospital, if there is a disease, you can go to the local regular hospital or the designated medical insurance hospital at any time, and the specific policy is implemented according to your local medical insurance system.

Legal basis: Social Insurance Law of the People's Republic of China

Article 1 This Law is enacted in accordance with the Constitution so as to regulate social insurance relations, safeguard the lawful rights and interests of citizens to participate in social insurance and enjoy the benefits of social insurance benefits, enable citizens to share the fruits of development, and promote social harmony and stability.

Article 2: The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to ensure citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, loss of early employment, childbirth, and so forth.

Article 3: The social insurance system adheres to the principles of wide coverage, basic protection, multi-level, and sustainability, and the level of social insurance shall be commensurate with the level of economic and social development.

Article 4 Employers and individuals within the territory of the People's Republic of China who pay social insurance premiums in accordance with law have the right to inquire about payment records and records of individual rights and interests, and to request social insurance agencies to provide social insurance consultation and other related services.

Legal analysis: Employees are hospitalized twice a year by medical insurance, and the reimbursement ratio within the scope of medical insurance is the same. Generally speaking, the economic development situation of different regions is different, so the reimbursement ratio is also different.

Legal basis: Article 30 of the Social Insurance Law of the People's Republic of China The following medical expenses are not included in the scope of payment of basic medical insurance**

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Seeking medical treatment outside the country.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

1. If we talk about medical insurance, the reimbursement ratio of the first and second hospitalizations depends on several factors: 1. In-service or retirement 2, the starting line 3, the amount of medical expenses 4, the level of the hospital for medical treatment, no matter how many times the overall reimbursement rules are unchanged, and the specific policies in different regions may be different, you can consult the local social security bureau. 2. The medical expenses incurred in multiple hospitalizations in a year can be reimbursed in accordance with the local medical insurance policies as long as they are within the scope of medical insurance.

The main expenses are the daily inpatient room expenses, the doctor's expenses during the hospitalization, the cost of using hospital equipment, the cost of surgery, medical expenses, etc. The length of hospital stay will have a direct impact on the cost. 3. Pay attention to the scope of diagnosis and treatment items that are not covered by medical insurance reimbursement.