北京社保卡怎么报销

Beijing Social Security Card Reimbursement

在北京，社保卡的报销是一项关系到众多居民医疗费用负担的重要事项。那么，北京社保卡究竟是怎么报销的呢？

In Beijing, the reimbursement of the social security card is an important matter related to the burden of medical expenses for many residents. So, how exactly is the Beijing Social Security Card reimbursed?

首先，享受北京社保卡报销待遇，需要满足一定的条件。参保人必须在北京市参加基本医疗保险，并且参保人或参保公司不能中断缴交医疗保险费。

First of all, to enjoy the reimbursement treatment of the Beijing Social Security Card, certain conditions must be met. The insured person must participate in the basic medical insurance in Beijing, and the insured person or the insured company cannot interrupt the payment of medical insurance premiums.

北京社保卡的报销范围包括个人账户、基本医疗保险统筹基金和大额医疗互助基金报销范围。个人账户方面，涵盖了门诊、急诊的医疗费用，以及超过基本医疗保险统筹基金起付标准、按照比例应当由个人负担的医疗费用。基本医疗保险统筹基金方面，包括急诊抢救留观并收入住院治疗的，其住院前留观 7 日内的医疗费用，还有恶性肿瘤放射治疗和化学治疗、肾透析、肾移植后服抗排异药的门诊医疗费用。大额医疗互助基金主要用于按比例支付职工和退休人员在一个年度内累计超过起付标准的门诊、急诊医疗费用和超过基本医疗保险统筹基金最高支付限额（不含起付标准以下以及个人负担部分）的医疗费用。

The reimbursement scope of the Beijing Social Security Card includes the personal account, the overall planning fund of basic medical insurance, and the reimbursement scope of the large-scale medical mutual aid fund. In terms of personal accounts, it covers the medical expenses of outpatient and emergency treatment, as well as the medical expenses that exceed the starting standard of the overall planning fund of basic medical insurance and should be borne by individuals in proportion. In terms of the overall planning fund of basic medical insurance, it includes the medical expenses of emergency rescue and observation before hospitalization within 7 days before hospitalization, as well as the outpatient medical expenses of radiotherapy and chemotherapy for malignant tumors, renal dialysis, and anti-rejection drugs after kidney transplantation. The large-scale medical mutual aid fund is mainly used to proportionally pay the outpatient and emergency medical expenses that employees and retirees have accumulated within one year and exceed the starting standard, and the medical expenses that exceed the maximum payment limit of the overall planning fund of basic medical insurance (excluding the part below the starting standard and the part borne by individuals).

在一个医疗保险年度内，城乡居民医保门（急）诊的起付标准有所不同。一级及以下定点医疗机构为 100 元，二级及以上定点医疗机构为 550 元，起付标准分别计算。起付标准以上部分由城乡居民医保基金按比例支付，支付比例为：一级及以下定点医疗机构 55%、二级及以上定点医疗机构 50%，累计最高支付数额为 3000 元。

Within a medical insurance year, the starting standards for outpatient and emergency treatment of urban and rural residents' medical insurance are different. For first-level and below designated medical institutions, it is 100 yuan, and for second-level and above designated medical institutions, it is 550 yuan. The starting standards are calculated separately. The portion above the starting standard is paid by the urban and rural residents' medical insurance fund in proportion. The payment ratios are: 55% for first-level and below designated medical institutions and 50% for second-level and above designated medical institutions, with a cumulative maximum payment amount of 3,000 yuan.

城乡老年人、劳动年龄内居民医保首次住院的起付标准也有规定：一级及以下定点医疗机构 300 元、二级定点医疗机构 800 元、三级定点医疗机构 1300 元，第二次及以后住院按首次住院起付标准的 50%确定。学生儿童住院的起付标准为：一级及以下定点医疗机构 150 元、二级定点医疗机构 400 元、三级定点医疗机构 650 元。起付标准以上部分由城乡居民医保基金按比例支付，支付比例为：一级及以下定点医疗机构 80%、二级定点医疗机构 78%、三级定点医疗机构 75%，累计最高支付数额为 20 万元。

There are also regulations on the starting standards for the first hospitalization of medical insurance for urban and rural elderly and residents within the working age: 300 yuan for first-level and below designated medical institutions, 800 yuan for second-level designated medical institutions, and 1,300 yuan for third-level designated medical institutions. For the second and subsequent hospitalizations, it is determined as 50% of the starting standard for the first hospitalization. The starting standards for hospitalization of student children are: 150 yuan for first-level and below designated medical institutions, 400 yuan for second-level designated medical institutions, and 650 yuan for third-level designated medical institutions. The portion above the starting standard is paid by the urban and rural residents' medical insurance fund in proportion. The payment ratios are: 80% for first-level and below designated medical institutions, 78% for second-level designated medical institutions, and 75% for third-level designated medical institutions, with a cumulative maximum payment amount of 200,000 yuan.

北京社保的医疗报销分门诊和住院两种。门诊方面，起付线为 1800 元，低于 1800 元的部分自付，1800 - 4.2 万的部分报 70%，4.2 万以上的部分自付。住院方面，起付线为 1300 元，低于 1300 元的部分自付，1300 - 7 万的部分报 85 - 97%，7 万 - 17 万的部分报 90%。住院的报销方式与门诊不同，这里所指的额度是指报回来的额度，最高可报回 17 万，但是如果真要报回 17 万的话，基本上要先花费 22.5 万左右。

The medical reimbursement of Beijing Social Security is divided into outpatient and inpatient. For outpatient, the starting line is 1,800 yuan. The part below 1,800 yuan is paid by oneself. 70% is reimbursed for the part between 1,800 and 42,000 yuan, and the part above 42,000 yuan is paid by oneself. For inpatient, the starting line is 1,300 yuan. The part below 1,300 yuan is paid by oneself. 85 - 97% is reimbursed for the part between 1,300 and 70,000 yuan, and 90% is reimbursed for the part between 70,000 and 170,000 yuan. The reimbursement method for inpatient is different from that for outpatient. The amount referred to here refers to the amount reimbursed. The maximum amount that can be reimbursed is 170,000 yuan. However, if you really want to be reimbursed 170,000 yuan, you basically need to spend about 225,000 yuan first.

总之，了解北京社保卡的报销规定和流程对于保障自身的医疗权益至关重要。希望以上内容能对您有所帮助。

In conclusion, understanding the reimbursement regulations and processes of the Beijing Social Security Card is crucial for safeguarding your own medical rights and interests. I hope the above content can be helpful to you.