We all know that medical insurance is a matter of great concern to the state, and the matters of the General Assembly every year will mention medical-related issues. Our country for different groups of people, the implementation of different policies, including urban workers medical insurance is one of them. First, the city employees health insurance reimbursement process 1, the insured person is sick in the city's three hospitals (or specialized hospitals) difficult to diagnose or no means of treatment, you can apply for transfer to a foreign hospitalization and treatment. 2, the transfer of foreign hospitals to fill out an application form, the city's three or more designated hospitals signing the opinion of the city's health insurance agency for review and filing after the transfer of the treatment of foreign 3, the insured person in the foreign place of a sudden illness in the hospitalization of local designated medical institutions, the hospitalization of the insured person in the local hospitalization of the hospital. The participant should be hospitalized in the local designated medical institution and call the city health insurance center for record within 3 days after admission.4. The medical fee for transferring to another hospital and emergency treatment in other places shall be paid by the individual first and reimbursed by the city health insurance center within one month after discharge from the hospital. Reimbursement materials: transfer approval form; detailed list of hospitalization expenses; invoices; discharge summary and save the relevant documents and information. Second, the urban workers health insurance reimbursement ratio of hospitalization reimbursement standard and the hospital level of the insured person, such as living in a third-class hospital, from the starting standard to 30,000 yuan of costs, the employee pays 15%, or reimbursement of 85%; 30,000 yuan to 40,000 yuan of costs, the employee pays 10%, reimbursement of 90%; more than 40,000 yuan of the costs of the maximum payment limit part of the cost of 95% of the reimbursement, the employee only need to pay 5%. The proportion of individual payment for retirees is 60% of that for active (that is, the above-mentioned) employees, but anything below the starting standard is paid by the individual. The prerequisites for reimbursement of urban workers' medical insurance are: 1) The applicant has gone through the procedure of enrollment and paid the full amount of medical insurance premiums; 2) The participant has incurred inpatient medical expenses in the medical institution of record and has paid the cash in advance, and has kept the relevant documents and information; 3) The participant has gone to the medical institution designated for cooperative medical care: the participant has incurred general outpatient, outpatient, and outpatient medical expenses in the medical insurance designated hospitals of his/her own choosing or in the specialized hospitals, traditional Chinese medicine hospitals, and Class A hospitals. The general outpatient and emergency expenses incurred in the hospitals of one's choice, Chinese medicine hospitals and Class A hospitals.4. Prepare the original invoices: general outpatient and emergency expenses are paid in cash by the individual, and the medical expenses incurred should be within the scope of the three major directories of the medical insurance pool.5. Bring along the medical insurance card and the ID card of the participant: from the first to the twentieth day of each month, the expenses incurred in that month will be declared in the following month, and the current year will be reimbursed by the twentieth day of January in the following year.6. The participant will hand in the bills to the unit or social security office. to the unit or the social security office, the unit or the social security office will enter the documents into the enterprise version, and then declare the electronic information and the documents to the medical insurance center. The reimbursement process of urban workers' medical insurance is roughly like this: you need to go to the local medical management center or designated medical institutions to reimburse the medical insurance checkout window. The procedures include: ID card, medical insurance card, original invoice, medication list, medical record, list, admission/discharge certificate and other materials. The above is the urban workers health insurance reimbursement process, I hope to help you.
Legal Objective:Article 28 of the Social Insurance Law: Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations. Article 29 of the Social Insurance Law: The portion of a participant's medical expenses that should be paid out of the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses incurred in other places to facilitate the enjoyment of basic medical insurance by insured persons.