1, the main purpose of medical insurance is to pay for outpatient treatment.

2. Medical insurance has other uses. You can use this money to buy medicines (over-the-counter medicines), medical instruments, thermometers and sphygmomanometers at designated pharmacies. You can also pay for self-funded items such as physical examination.

Second, the new use of medical insurance card

1 can be used as an ID card.

20 15 10 1, the criminal law amendment (IX) included the social security card in the scope of documents that can be used to prove identity according to law. Whoever forges, alters or buys or sells social security cards shall be investigated for criminal responsibility according to law; Anyone who uses a forged, altered or embezzled social security card of others shall be investigated for criminal responsibility according to law.

2. Some provinces and cities can keep fit.

In the second half of this year, in some provinces and cities in Shandong, Chongqing and Jiangsu, employees themselves can use their personal account balance to carry out fitness activities in fitness venues. But it shall not be used to buy food, clothing, fitness equipment or cash.

How to use the money in the medical insurance card account?

As we all know, employee medical insurance is generally divided into personal accounts and overall accounts. How to use these two accounts respectively?

Personal accounts can pay the following fees:

1, drug purchase expenses of designated retail pharmacies, outpatient and emergency medical expenses;

2. It is used for me to purchase commercial insurance and accident insurance;

3, the basic medical insurance fund Qifubiaozhun below the medical expenses;

4, more than the basic medical insurance fund Qifubiaozhun part, pay personal expenses in proportion;

5. I'll pay for the part of my personal account that is insufficient to pay.

The overall fund mainly pays the following fees:

1, hospitalization expenses;

2, malignant tumor radiotherapy, renal dialysis, kidney transplantation after taking anti-rejection drugs outpatient medical expenses;

3, emergency rescue income hospitalized patients, the medical expenses within seven days before hospitalization.

Scope of medical insurance reimbursement

1, medical insurance card reimbursement is limited to medical expenses above hospitalization in designated hospitals due to diseases and some accidents.

The reimbursement formula is: (total cost-threshold cost-self-funded cost-cost overrun) *(75+ age *0.2)%. In general, the actual reimbursement rate ranges from 20% to 60%.

Self-funded drugs are not reimbursed, and 80% of Class B drugs are reimbursed. The bed fee is limited, and some inspection fees and medical treatment fees cannot be reimbursed according to regulations.

2. The reimbursement amount of the medical insurance card is 4 times of the local social wage (1 year accumulated value).

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

4, serious illness insurance reimbursement

After the insured suffers from a serious illness, the personal conceit part that meets the requirements of the municipal medical insurance in the designated medical institutions of the municipal medical insurance shall be included in the payment scope of the residents' serious illness insurance, and 50% shall be reimbursed by the serious illness insurance fund.

Namely: reimbursement amount = 50% of the self-funded part.

Medical insurance card reimbursement ratio

In July this year, Ministry of Human Resources and Social Security announced the 13th Five-Year Plan for the development of human resources and social security. China should stabilize the proportion of hospitalization expenses in the basic medical insurance policy for employees and urban and rural residents at around 75%.

Pay attention to using medical insurance card!

1. Cash withdrawal is prohibited.

No unit or individual may violate the scope and requirements of the medical insurance card, and it is strictly forbidden to take cash.

2. Some provincial and municipal medical insurance cards can be used by the whole family.

Starting from the second half of this year, in some provinces and cities such as Zhejiang Province and Guangzhou City, the surplus funds of individual medical insurance accounts over the years can be used to pay the medical insurance expenses of the spouses, children, parents and other close relatives of employees' basic medical insurance participants, so as to realize mutual assistance among family members.

3. The following medical insurance will not be paid.

See a doctor in a non-designated medical institution or buy medicine in a non-designated retail pharmacy (except for emergency);

Self-injury caused by fighting, drug abuse or other illegal acts;

Treatment for alcoholism, suicide, self-mutilation, etc.;

Injuries caused by traffic accidents, medical accidents or other accidents;

And the situation that should be paid by individuals according to national or local regulations.

3. How to check the balance of the medical insurance card?

Insured persons can call 12333 for social security consultation or check the balance of medical insurance personal account through BOC savings office, designated hospitals in urban areas and pharmacies.

Editor's Note: In principle, medical insurance is implemented at the municipal level, so the regulations will be different across the country, depending on local conditions.

If you are not clear about medical insurance, you can call the human resources and social security hotline 12333.