Can I still enjoy medical insurance reimbursement? , the money in the medical insurance card has run out
Xiao Wang has just been working for a company for a year. He fell ill not long ago and went to the hospital to get a lot of medicine. During his recent follow-up visit, he found that the money in his medical insurance card had been used up. Xiao Wang would like to ask, if there is no money in the medical insurance card, can I still use the medical insurance card to see a doctor in the hospital outpatient department and enjoy medical insurance reimbursement?
Answer: According to the official public account of "Shanghai Medical Insurance", if the money in the medical insurance card is used up, the money in the personal medical insurance account is used up. As long as employees are still paying for employee medical insurance normally, they can still enjoy medical insurance reimbursement.
On July 1, 2023, the city's employee medical insurance entered the 2023 medical insurance year. The official website of Shanghai Medical Insurance also released a policy interpretation of the "Notice on Matters Concerning the Conversion of the City's Basic Medical Insurance in the 2023 Medical Insurance Year", which pointed out that outpatient and emergency services for active employees The standard for self-payment has been reduced from the original 1,500 yuan to 500 yuan; the reimbursement proportions for outpatient and emergency medical expenses in first-, second-, and third-level hospitals have been increased to 80%, 75%, and 70% respectively for medical expenses that exceed the personal burden. . The threshold for outpatient reimbursement for retirees has also been reduced by varying degrees from 100 to 400 yuan, and the reimbursement ratio for some retirees has also been increased.
If the personal account has balance funds over the years, it can be offset against the personal self-pay part of the "self-payment period" and "co-payment period", and the shortfall will be borne by the individual's cash.
The account funds for the current year here are the funds that are pre-accounted into the medical insurance personal account at the beginning of the medical insurance year on July 1 of each year; and the balance funds over the years are the funds that are settled and interest calculated according to regulations at the end of the year on June 30 of the following year. , funds retained in medical insurance personal accounts. Participants of employee medical insurance can self-check "medical insurance funds" through the application process, and the mobile phone interface will display "account balance for the current year" and "account balance over the past years". You can also inquire at each medical insurance handling service window.
Question: What are the differences between the "account section", "self-pay section" and "co-payment section" of employee medical insurance?
When the employee medical insurance system was established, an outpatient coordination system was simultaneously established, and a three-stage outpatient and emergency protection model was established, including account section, self-pay section and co-pay section.
"Account segment" refers to the medical expenses incurred by employees' medical insurance insured outpatient and emergency medical treatment in a medical insurance year that are eligible for payment by basic medical insurance and are first paid by the insured's personal account fund for that year.
The "self-pay period" refers to a certain standard of expenses that individuals must bear first according to regulations before the outpatient and emergency medical expenses incurred by the insured that are paid by basic medical insurance are paid by the medical insurance fund after the personal account funds are used up in the current year.
"Co-payment segment" refers to the outpatient and emergency medical expenses that exceed the standard of the self-pay segment and are covered by basic medical insurance, and are borne jointly by the medical insurance fund and the insured.