Now medical insurance has been basically popularized. More and more people pay attention to the payment and use of medical insurance. Medical insurance can reduce the burden of seeing a doctor and taking medicine for everyone. People who use medical insurance to see a doctor will find that there are a few hospitals in medical insurance, but many people don't understand what medical insurance designated hospitals mean? What is the use of medical insurance designated hospitals and what is the reimbursement method and proportion of medical insurance designated hospitals? This article introduces the use and reimbursement of designated medical insurance hospitals. Let's have a look.
What does the designated hospital of medical insurance refer to
Medical insurance designated hospitals refer to the list of hospitals with social insurance medical qualification in the jurisdiction area published by the social security department. The insured selects the hospital for medical treatment according to the published list, and then the social security department will issue the medical insurance card to the medical insurance participants after passing the examination. With the medical insurance card, they can go to the designated hospital for medical treatment, and the medical expenses can be reimbursed according to relevant regulations, Otherwise, medical expenses cannot be reimbursed. The designated hospital of medical insurance is a medical institution that provides medical services for the insured of basic medical insurance for urban employees and undertakes corresponding responsibilities after being reviewed by the administrative department of labor and social security in the overall planning area, signed an agreement with the medical insurance agency, and determined by the social security agency.
What is the use of medical insurance designated hospitals
Above, we briefly introduced the concept of medical insurance designated hospital. So what's the use of medical insurance designated hospitals?
1、 You can apply for medical insurance reimbursement.
2、 Social medical insurance reimbursement is reimbursed after discharge or transfer.
3、 Settlement procedures for inpatient and outpatient treatment of special diseases: the designated medical institution shall report the expense settlement sheet, inpatient settlement sheet and relevant data of the discharged patients in the previous month to the medical insurance agency before the 10th day of each month. After the medical insurance agency reviews it, it shall be used as the basis for monthly budget and year-end final accounts; The medical insurance agency shall allocate the overall expenses of hospitalization and outpatient treatment of special diseases in the previous month in advance every month; The insured with special diseases shall go to a designated medical institution designated by the labor and social security department for medical treatment and purchase drugs, and the medical expenses incurred shall be directly recorded and settled immediately.
In the management of designated medical institutions of basic medical insurance, although patients can not choose what kind of medical services to obtain, they can independently choose the medical institutions and doctors to provide services within the designated scope. In this way, if the services provided by medical institutions can not meet the needs of patients, the cost is too high, the quality is not good, the treatment is inconvenient or the service attitude is not good, the insured can enter the 'gate' of other medical institutions to obtain satisfactory services. This will promote medical institutions to improve service quality in an all-round way, improve service attitude and treatment conditions, reduce and control medical costs, and attract insured personnel to seek medical treatment.
How to choose a designated hospital for medical insurance
The medical insurance manual is mainly for the control of designated hospitals. According to the principle of "nearby medical treatment and convenient management", in principle, everyone can choose four medical institutions for medical treatment within the designated medical institutions of basic medical insurance in the district and county where the unit and residence are located, including one designated grass-roots medical institution (including medical institutions in community health service centers and stations, factories, mines and colleges). All designated hospitals marked as "level I" and "other" in the "hospital level" are designated hospitals for primary medical treatment.
There are five hospitals (4 + 1) in the medical insurance manual. You can choose four designated hospitals (including one grass-roots community hospital) and one community service station. Note that this fifth is a community service station, which is only a service point opened by the community hospital, not the community hospital itself. Generally, four designated hospitals can be selected.
How does the medical insurance designated hospital reimburse
[outpatient reimbursement method]: if there is a designated hospital with computer networking in the city for medical treatment, it shall be settled directly at the outpatient charging Office of the hospital with its own ID card and agreement; For those who seek medical treatment in other designated hospitals without computer networking, the medical expenses shall be paid in advance by the individual. Within three months, they shall go through the reimbursement procedures in the medical insurance Department of the social security bureau with their own ID card, medical IC card (if there is no IC card, the original and copy of the bank current passbook), outpatient medical records, medical receipts and expense list details.
[reimbursement for urban and rural residents]:
1. The insured urban and rural residents hold their residence booklet or ID card to the designated township health centers, community health service centers and village health stations for outpatient treatment. The outpatient medical expenses incurred shall be recorded into the medical insurance information management system by the designated medical institutions for diagnosis and treatment and settled immediately.
2. The designated medical institution shall apply for settlement to the local medical insurance bureau on a quarterly basis with invoices, prescriptions (patient signature), general outpatient medical expense summary sheet and other data.
What is the reimbursement proportion of medical insurance designated hospitals
The reimbursement proportion of compliant medical expenses incurred in designated hospitals will vary according to different grades, as follows:
1. Residents participate in grade a medical insurance (80 yuan per person per year), and the maximum payment limit within the fund year is 300000 yuan. The reimbursement proportion in class I hospitals is 95%, that in class II hospitals is 75%, and that in class III hospitals is 65%;
2. Residents participate in medical insurance grade B (170 yuan per person per year), and the maximum payment limit of the fund is 400000 yuan per year. The reimbursement proportion in class I hospitals is 95%, that in class II hospitals is 85%, and that in class III hospitals is 75%.
The reimbursement proportion will vary with the level of medical insurance insured by residents. If you need to know the reimbursement proportion of local medical insurance.
Problem solving
[q] how much does the medical insurance card cost per month?
[answer] generally speaking, ordinary medical insurance is allocated to personal accounts by medical insurance companies according to a certain ratio of paid wages and age. 12 times a year. The monthly return of medical insurance to personal account is uncertain, and the return proportion is as follows:
（1） Under the age of 35, the monthly arrival is 2% of the social security payment base (individual payment);
（2） 35-45 years old, 2% of the social security payment base (individual payment part) + 1% allocated by the unit;
（3） 45 years old - retired, the monthly arrival is 2% of the social security contribution base (individual payment part) + 1.8% allocated by the unit;
（4） After retirement, the monthly income shall be 4.1% of the average salary of Guangzhou in the previous year.
[q] how do you buy medicine at the designated drugstore of medical insurance?
[answer] when purchasing drugs at designated retail pharmacies, if the insured participates in the personal account of medical insurance, he can use the funds in the personal account to purchase drugs; In addition, if there are funds deposited in the financial account of the social security card, it also has the payment function equivalent to the ordinary bank card, which can be used to purchase medicine. If the accumulated amount in the personal account of the first-class insured of basic medical insurance exceeds 5% of the average salary of on-the-job employees in the city in the previous year, the excess part can be used to pay the following expenses:
（1） The cost of over-the-counter drugs within the scope of the drug catalogue of basic medical insurance and local supplementary medical insurance purchased at the designated retail drugstore;
（2） The basic medical expenses and local supplementary medical expenses paid by myself and his spouse and immediate family members who have participated in the basic medical insurance of this city when they see a doctor in a designated medical institution;
（3） The expenses for physical examination and vaccination of himself and his spouse and immediate family members who have participated in the basic medical insurance of this city;
（4） Other medical expenses stipulated by the state, province and this Municipality.
[question] how to change the designated hospital selected on the medical insurance card?
[answer] the designated medical institution can be changed. Now the process of changing the hospital can be directly operated in your unit. Find the person in charge of social security in your unit, he can operate at that time, and the changed hospital will take effect the next day. Another way is to go to the local medical insurance service administration to apply for change.