Go to social security center reimbursement to take what procedur

1.

1. Materials required for outpatient reimbursement: original medical information such as outpatient medical records, inspection and test results report; Original ID card; Original medical diagnosis certificate; The original receipt of general outpatient and emergency charges, the detailed list of outpatient charges or the original prescription (the prescription is pasted on the back of the receipt by date)

2. Materials required for reimbursement of childbearing expenses: one original and one of childbearing service certificate; A of the baby's birth certificate; One of medical diagnosis certificate; All the original receipts and prescriptions (Chinese and Western medicine expenses) are sorted out according to the date. The medical expenses of 4 yuan can be reimbursed

3. Materials required for reimbursement of work-related injury: the application form for identification of work-related injury is in quadruplicate, and the is invalid One original and one of diagnosis certificate and outpatient (inpatient) cases or occupational disease diagnosis certificate; One original and one of the labor contract; A of ID card of the injured person

extended data

social insurance reimbursement refers to the behavior that social insurance compensates the medical expenses, childbearing expenses and work-related injury treatment expenses of employees and residents in proportion

social security card has a wide range of functions. Cardholders can not only make real-time settlement of medical insurance personal accounts with their cards, but also handle endowment insurance affairs; Apply for job registration and unemployment registration; Apply for unemployment insurance benefits; Apply for employment training; Apply for labor ability appraisal and enjoy instrial injury insurance benefits; Handle labor and social security affairs on the Internet

Network - Social Security reimbursement

Network - social security card of the people's Republic of China

2. 1、 Medical expenses documents sorting. 1. The outpatient and emergency department of the insured unit can be reimbursed. In service employees can only be reimbursed if they are more than 1800 (if they can't make up enough within one year, they will enter supplementary medical treatment). Retirees can only be reimbursed if they are more than 1300. 2. The reimbursement time is from the 1st to the 20th of each month, and the expenses of the current year will be declared before the 20th of the next year. 3. When declaring, a detailed statement of settlement shall be sealed. B two copies of approval form with official seal C outpatient department, the original of emergency receipt (if there is a drug charge, the prescription of some hospitals should be printed below the original of the receipt) d receipt details, the details of various expenses e when seeing a doctor, except for the hospitals written on the blueprint and other hospitals that do not need the blueprint, the remaining hospitals can only see the emergency department. F in case of emergency observation and hospitalization observation, the reimbursement ring the period before hospitalization is the same as that ring hospitalization. 4. Expenses incurred in other places, can not return to Beijing for treatment, can be reimbursed, but must provide travel proof. Retirees' expenses incurred in other places can only be reimbursed by visiting relatives, and other expenses will not be handled. 2、 First of all, go to the third floor (Haidian District Social Security Center) to import personnel information. 2. Manual reimbursement is divided into upload and non upload. Upload is a sign in the upper right corner of the invoice. There's nothing to upload. 3. Pay special attention to the cost of diagnosis and treatment (composed of two parts, in which the registration part is not used). A. outpatient non upload operation: 1. Medical common input - & gt; General outpatient expenses entry - & gt; Input number - & gt; Query, to a document a document record, record number is the number under the bar code, that is the document number, no number is not recorded-& gt; New - & gt; Unit information - & gt; Save (if you want to record the next one, just add a new one) - & gt; Generate approval - & gt; Confirm - & gt; Audit form (in plicate) with official seal. The diagnosis and treatment fee can be entered in the treatment fee, one by one, or together (summary). Finally, after all the information is entered, an approval form is generated. 2. If you can't tell the difference between self payment and non fee, you can enter them all. Social security has been audited. 3. The approval form should be placed one by one. 4. Then there is the data offer - & gt; General outpatient service - & gt; Query - & gt; Offer - & gt; Save as - & gt; File name (cannot modify file name and format) save - & gt; Print the detailed summary (in plicate) and finally print one. 5. In a word, the reimbursement materials are: receipt, approval form, summary form and USB flash disk. B for uploaded bills: 1. Uploaded expense management - & gt; Uploaded - & gt; Upload the bill entry information (the same as before) - & gt; Input one by one - & gt; Save - & gt; To generate an approval, the documents are set on the approval document (one person makes one set). The data submission is the same as that of the above non upload documents - generate the file name (the file name cannot be changed). PS: when making an offer, the documents are submitted together (for example, 10 persons are summarized together). If one person has a non upload document and an upload document, it is calculated separately, not by person, but by type. 2. After the social security is recovered, the receipt will be issued. C reimbursement error change: non upload: comprehensive query - & gt; Offer history query (general clinic) - & gt; Enter company name and offer date - & gt; Query - & gt; Click the information you want to change (offer transaction on the left) - & gt; Click offer back - & gt; The input approval window will appear, and then modify it. Comprehensive query - & gt; Approval history query - & gt; Select the information to change - & gt; Back - & gt; The initial general outpatient inquiry PS: if there is no offer and the approval form has been printed out, it can be directly changed from the approval form. Upload: upload historical data - & gt; Back - & gt; Approval form - & gt; Back - & gt; Do it again.

3.

The proceres are as follows:

1. On admission: Patients with medical insurance should go through the social security registration proceres with their ID cards, and then go to the ward for hospitalization

2. When discharged: the doctor arranged the patient to be discharged, and went to the charge office to handle the discharge settlement proceres with the admission registration form and ID card

at present, the reimbursement process has been simplified. Patients do not need to go to the social security center for reimbursement, and can settle accounts directly in the hospital

the so-called hospitalization reimbursement of medical insurance is not that you pay cash in advance and then pay with bills, but that when you are hospitalized in a designated hospital of medical insurance, you issue a medical insurance card to let the unified medical insurance settlement system read the information of the insured and handle the hospitalization number. When you are discharged from the hospital, the medical insurance system will not receive the "part of the reimbursement" - the overall payment part

extended data

reimbursement scope of medical insurance:

1. The reimbursement of medical insurance card is limited to the medical expenses above hospitalization caused by diseases and some accidents in designated hospitals

the reimbursement formula is as follows: (total expenses - threshold expenses - self expense - overspending expenses) * (75 + age * 0.2)%. Under normal circumstances, the actual reimbursement proportion varies from 20% to 60%

self funded drugs are not reimbursable, class B drugs are reimbursable by 80%, bed fee is limited, and some inspection fee and diagnosis and treatment fee according to the regulations are not reimbursable

2. The reimbursement amount of medical insurance card is 4 times of the average salary of local social workers (accumulated value within one year)

3. The money in the medical insurance card can be used to buy medicine in the designated drugstore and pay for outpatient and emergency expenses, but it does not belong to the reimbursement category, because the money in the medical insurance card is the money in the medical insurance indivial account

4. Reimbursement of serious illness insurance

after a serious illness occurs to the insured, the part of indivial's own responsibility that occurs in the designated medical institutions of the city's medical insurance and conforms to the provisions of the city's medical insurance will be included in the payment scope of residents' serious illness insurance, and 50% will be reimbursed by the serious illness insurance fund

that is, the reimbursement amount = the self financing part × 50%

4.

The following information is required for reimbursement:

1. Original ID card or social security card

2. The original diagnosis certificate issued by the doctors of designated medical institutions

3. Outpatient medical records, examination, test results report and other original medical information

4. The original receipt of outpatient charges of medical institutions unified by finance and tax

5. The detailed list of outpatient expenses printed by the hospital computer or the original payer's prescription issued by the doctor

6. Designated drugstores: the original of unified invoice and computer printed list for tax commodity sales,

7. If it is handled on behalf of a person, the original ID card of the agent shall be provided

materials required for instrial injury reimbursement:

Application Form for instrial injury identification in quadruplicate, invalid One original and one of diagnosis certificate and outpatient (inpatient) cases or occupational disease diagnosis certificate; One original and one of the labor contract; A of ID card of the injured person

extended data:

hospitalization:

1. Reimbursement scope: the hospitalization expenses of the insured in the designated hospital or specialized hospital of medical insurance, traditional Chinese medicine hospital and class a hospital selected by indivials

2. Hospitalization starting line: in a natural year, the first hospitalization starting standard is 1300 yuan, and then 650 yuan each time

3. Reimbursement proportion: 90% in the first level hospital, 87% in the second level hospital, and 85% in the third level hospital, with a total reimbursement of 300000 yuan

4. Handling process: please use the "Beijing Medical Insurance Manual" when seeing a doctor. If the unit pays in full, the indivial only needs to pay part of the hospitalization prepayment to go through the hospitalization proceres. The medical expenses incurred should meet the scope of medical insurance. When leaving the hospital, the hospital and the indivial should settle the part of their own expenses, and the reimbursement amount of the overall fund should be settled by the hospital and the district medical insurance center

5.

1、 Medical reimbursement

1. Original ID card

2. Original medical diagnosis certificate

3. Outpatient medical records, examination, test results report and other original medical information

4. Original receipt of general outpatient and emergency charges,

5. Detailed list of outpatient charges or original prescription (the prescription is pasted behind the receipt by date)

(2) birth allowance (1), original and one of marriage certificate

2. One original and one of birth service certificate

3. One original and one of the birth certificate

4. One original and one of medical diagnosis certificate

5. The registration form of information of applicants for maternity allowance is made in plicate (it must be filled in with black signature pen)

extended data:

premium calculation:

payment amount = payment base * payment proportion

the payment base of social security refers to the wage base used by enterprises or indivial employees to calculate and pay social insurance premium, and the amount of social insurance premium that enterprises or indivials should pay is multiplied by the specified rate

the social security payment base of each region is linked with the local average wage data. It is determined according to the monthly average amount of all wage income from January to December of the previous year. It is determined once a year, and after it is determined, it will not change within a year. The time for declaration and adjustment of social security base is usually in July

enterprises generally take the total wages of enterprise employees as the payment base, while half of indivial employees take their monthly average wages of the previous year as the wage base of indivial social insurance premiums. In China, the payment base is verified by the social insurance agency according to the declaration of the employer

6. Social insurance reimbursement refers to the behavior that social insurance compensates medical expenses, childbearing expenses and instrial injury treatment expenses of employees and residents in proportion. Social security reimbursement mainly includes maternity insurance reimbursement and work-related injury insurance reimbursement. The reimbursement methods of social medical insurance vary from place to place< Medical reimbursement:

1. Outpatient service

(1) use the medical insurance card to go to the outpatient service for real-time settlement without reimbursement

(2) if you go to the outpatient clinic without medical insurance card, please use the "Beijing Medical Insurance Manual" (medical blueprint)

1. Reimbursement scope: the general outpatient and emergency expenses incurred by the insured in the designated hospital or specialized hospital of medical insurance, traditional Chinese medicine hospital and class a hospital

2. Outpatient starting line: the total outpatient and emergency expenses in a natural year exceed 1800 yuan

3. Reimbursement ratio: 70% for the part above 1800 yuan, 90% for the community, and 20000 yuan for the top line

4. Required materials:

original ID card

original medical diagnosis certificate

the original of outpatient medical records, examination, test results report and other medical information

the original receipt of general outpatient and emergency charges,

the detailed list of outpatient charges or the original prescription (the prescription is pasted behind the receipt by date)

5. Submission time: from the 1st to 10th of each month. The expenses of the current month should be submitted in the next month, and the expenses of the current year should be submitted before January of the next year

6. Handling process: in a natural year, if the accumulative amount exceeds the minimum payment standard, the unit operator will input all the documents into the enterprise version software, and report the generated electronic information and reports to the medical insurance center. The medical insurance center will complete the audit, settlement and payment within 30 working days< 1. Reimbursement scope: the hospitalization expenses of the insured in the designated hospitals or specialized hospitals, traditional Chinese medicine hospitals and class A hospitals of medical insurance selected by the insured

2. The starting payment line of hospitalization: in a natural year, the starting payment standard of the first hospitalization is 1300 yuan, and then 650 yuan each time

3. Reimbursement proportion: 90% in the first level hospital, 87% in the second level hospital, 85% in the third level hospital, and the total reimbursement amount is 300000 yuan

4. Handling process: please use the "Beijing Medical Insurance Manual" when seeing a doctor. If the unit pays in full, the indivial only needs to pay part of the hospitalization prepayment to go through the hospitalization proceres. The medical expenses incurred should meet the scope of medical insurance. When leaving the hospital, the hospital and the indivial should settle the part of the amount at their own expense, and the reimbursement amount of the co-ordination fund should be settled by the hospital and the district medical insurance center

maternity reimbursement:

I. maternity allowance

1. Required materials:

one original and one of marriage certificate

"birth service certificate" original and a

one original and one of the baby's birth certificate

one original and one of medical diagnosis certificate<

"registration form of information of Beijing fertility allowance applicants" in plicate (to be filled in with black signature pen)

note: the above copies must be on A4 paper

2. Submission time: 1-10 days of each month (2 months after the birth of the baby)

3. Handling process: the handling personnel of the unit shall submit the above materials to the social security center, and pay the maternity allowance within 30 working days after the approval

in case of meeting the conditions for enjoying the reward allowance for late childbearing (over 23 years old), both husband and wife should select the object of enjoying the late childbearing allowance in the information registration form of Beijing fertility allowance applicants, and both husband and wife should sign for confirmation in person and seal by both parties

if both husband and wife have participated in maternity insurance, the female unit shall fill in the information registration form of Beijing fertility allowance applicants; If the woman does not take part in the maternity insurance, and the man has taken part in the maternity insurance, and the man enjoys the late childbearing allowance, the man's unit shall fill in the information registration form of Beijing fertility allowance applicants (in plicate) and declare< 2. Medical expenses for childbirth (prenatal examination)

1. Required materials:

one original and one of childbirth service certificate

a of the baby's birth certificate< One of medical diagnosis certificate

all the original receipts and prescriptions (Chinese and Western medicine expenses) are sorted out according to the date, and the medical expenses of 4 yuan can be reimbursed

"Declaration Form for manual reimbursement of medical expenses of Beijing maternity insurance" (to be filled in with black signature pen)

2. Submission time: 1-10 days of each month (2 months after the birth of the baby)

3. Handling process: the agent of the insured unit shall submit the above materials to the social security center, and pay the maternity medical (prenatal examination) fee within 30 working days after accepting and approving< 3. Medical expenses of family planning operation (hospitalization expenses)

1. Required materials:

one original and one of birth service certificate

a of the baby's birth certificate< One of medical diagnosis certificate

the original of all receipts, prescriptions (Chinese and Western medicine expenses), hospitalization expenses details and hospitalization settlement list shall be sorted out according to the order of date (4 yuan of medical expenses can be reimbursed)

"Declaration Form for manual reimbursement of medical expenses of Beijing maternity insurance" (to be filled in with black signature pen)

2. Submission time: 1-10 days of each month (2 months after the birth of the baby)

3. Handling process: the handling personnel of the unit shall report the above materials to the social security center on the 1st-20th of each month, and pay the medical expenses of family planning operation within 30 working days after the approval< 1. Required materials:


Application Form for instrial injury identification in quadruplicate, invalid

one original and one of diagnosis certificate and outpatient (inpatient) cases or occupational disease diagnosis certificate

one original and one of the labor contract< One of ID card of the injured person

2. Submission time: from the 1st to 10th of each month

3. Handling process:

Application: the handling person of the unit reports the above materials to the social security center

acceptance: the work-related injury identification department shall review the application within 15 days after receiving it, and accept the qualified ones. If the application materials are not complete, the unit operator shall be informed to complete the materials within 30 days<

identification: within 60 days (another 30 days under special circumstances) after the examination, the instrial injury identification conclusion notice shall be made and the unit operator shall be informed; for those who do not meet the identification conditions, the unit operator shall be informed; for those who are identified as instrial injury, the instrial injury certificate shall be issued

appraisal: if the period of work stoppage and salary retention has expired or the injury is basically stable after treatment, the applicant shall submit the labor ability appraisal to the labor ability appraisal committee to assess the disability level

benefits of work-related injury insurance: if it meets the conditions for enjoying the benefits of work-related injury insurance, the agent of the unit applies to the social security center for the benefits audit. According to the approved benefits, the social security center will pay the benefits to the work-related injury employees within the specified time.