A, Hainan medical insurance reimbursement process and the materials requiredReimbursement conditions (a) employee medical insurance to enjoy the integrated payment conditions
1, the participants in the basic medical insurance, continuous contributions for a full year before enjoying a coordinated fund to pay treatment. If the continuous contribution is interrupted for 3 months or the cumulative interruption of contribution is 6 months, the entitlement to basic medical insurance treatment shall be stopped. After the resumption of contributions, the interruption of 3 consecutive months of contributions, after 6 months of continuous contributions to re-enjoy the integrated fund to pay treatment; cumulative interruption of 6 months of contributions, after 1 year of continuous contributions to re-enjoy the integrated fund to pay treatment. 2. Retirees participating in employee medical insurance, in accordance with the Regulations, the accumulated contribution period (including deemed contributions) to enjoy the corresponding medical treatment. If the accumulated contribution period is not enough, a one-time supplementary contribution can also be made in accordance with the relevant provisions of Article 27 of the Regulations. 3. Retirees who have never participated in basic medical insurance can enjoy the corresponding basic medical insurance treatment after making a one-time payment of 10 years of basic medical insurance compensation, and after the next month of payment in accordance with the regulations. 4. During the period of receiving unemployment insurance benefits, the unemployed will pay the basic medical insurance premiums from the Unemployment Insurance Fund and enjoy the basic medical insurance treatment for employees.Reimbursement materials I. Reimbursement of hospitalized medical expenses:
Computerized list, first page of the course of the disease, certificate of illness, discharge summary; ii. Other medical expenses reimbursement: Referral: 1, the designated medical institution referral approval form; 2, hospitalization invoice, hospitalization computer lists, discharge summary, proof of illness, ID card copy bank account number (bank account and account number); Residence in a different place, a different referral: Hospitalization invoice, hospitalization computer lists, discharge summary, proof of illness, ID card copy Bank account number (account bank and account number); iii. Urban residents: 1). Reimbursement of hospitalized medical expenses: With ID card (hukou book) or social security card valid documents. 2). Outpatient medical expense reimbursement: 1. General outpatient: resident medical insurance card 2. Special outpatient: (1), "Hainan urban residents basic medical insurance outpatient special disease identification form" (in duplicate); (2), my recent hospitalization diagnosis of disease certificate; (3), hospital discharge summary or examination report within the last six months; (4), Disease diagnosis certificate and other information; 3, foreign medical: (1.), social security card; (2), foreign referral approval form; (3), hospitalization invoices; (4), hospitalization home page and discharge summary; (5), the summary of the medical expenses detailed list; (6), reimbursement of the person's bankbook (account number) a copy of a copy of a copy; ( 7), hospitalized delivery also need to provide birth service certificate and birth certificate original and a copy of each other and other related information. Note: The information provided by the hospital must be stamped with the hospital sealReimbursement process (a) urban workers:
1. bulk reimbursement Referral from other places: (1), provide the designated medical institutions referral approval form (2), social security agencies to review and approve (3), hospital invoices, Hospitalization computer list, discharge summary, proof of illness, ID card copy bank account number (account opening bank and account number) (4), social security agency supervisors review (5), department head approval settlement team settlement Residence in a different place, business trips, vacations, or visiting relatives: (1), hospitalization invoices, hospitalization computer lists, discharge summary, proof of illness, ID card copy Bank account number (account opening bank and account number) (2), social security agency supervisors review (3), department head approval (4), settlement team settlement 2. Hospitalization reimbursement (1), the participant with his identity card in the city designated medical institutions for hospitalization procedures (2), when discharged from the hospital with the relevant materials (computerized lists, the first page of the course of the disease, The hospitalization reimbursement procedures are carried out directly in the hospital medical insurance office with the relevant materials (computerized list, the first page of the disease course, the certificate of disease, the discharge summary). 3. Foreign medical treatment Foreign referral: (1), tertiary hospital referral; (2), with ID card, referral approval form to the participant's local health insurance agency for approval; (3), the medical insurance agency for approval of the seal; (4), with the approval form to the designated medical institution hospitalization; (5) 5, with the settlement voucher and invoices to the participant's local medical institution after discharge. invoice back to the participating medical institutions for registration; (6) Medical unblocking. Residence in a different place: (1), the retirees who live outside the place of insurance for more than 6 months and the practitioners who have been on public assignment for more than 3 months can only apply for this medical procedure of residence in a different place; (2), the retirees receive the "Haikou City, Haikou City, urban workers residing in a different place of urban workers' health insurance hospital registration form"; (3), the seal of the designated hospitals of the region of the medical insurance in foreign areas and the medical insurance management department seal; (3), the seal of the hospitals of the region of foreign areas and the medical insurance management department in foreign areas; (5), the hospitals in foreign areas and the medical insurance management department seal. Medical insurance management department seal; (4), the retiree will be stamped form sent back to the Haikou Social Security Bureau of the medical section of the registration record; (5), if the unit needs to be permanently stationed outside of the workforce, you need to open the unit certificate; (6), participants will be reimbursed vouchers sent back to the Haikou Social Security Bureau of the reimbursement. (2) urban residents: 1. Hospitalization reimbursement residents health insurance participants in the designated medical institutions hospitalization reimbursement (1), the participant diagnosed by the designated medical institutions in need of hospitalization, you need to use the ID card (hukou book) or social security card valid documents in the designated medical institutions in the city to apply for hospitalization; (2), the designated medical institutions in the verification of the staff in the medical institutions. After checking their personal identity, health insurance contributions and the use of integrated funds, etc., according to the provisions of the integrated fund can be paid by the health insurance treatment of the person for hospitalization booking procedures; (3), discharge settlement, is the integrated fund of health insurance to pay for the medical costs of the fixed-point medical institutions and social security agencies, is the personal out-of-pocket medical expenses, the insured person and the fixed-point medical institutions settlement. 2. General outpatient reimbursement (1), the participant in the first level of designated medical institutions outpatient registration, medical (2), after the diagnosis and treatment of the participant with the residents' health insurance card directly in the hospital billing office settlement, reimbursement 3. Special outpatient treatment (1), the participant to apply for outpatient treatment of special diseases, the applicant needs to be to the city of the second level (including) or more or specialty designated medical institutions 3. (limited to the specialty disease) application, fill out the "Hainan Province urban residents basic medical insurance outpatient special disease identification form" (in duplicate), and at the same time, I recently hospitalized disease diagnosis certificate, discharge summary or nearly six months within the examination report, disease diagnosis certificate and other information; (2), according to the needs of the insured person can apply for two outpatient special disease, suffering from a variety of outpatient special diseases, should be According to the order of the main diseases suffered fill in; (3), by the designated medical institutions of the medical insurance office for preliminary examination, meet the reporting conditions of the municipal social security bureau of the medical supervision and audit team of the agency to make a review of the audit opinion after signing and stamping the official seal, entered into the system, the applicant to enjoy the treatment; (4), the insured person can be in the local social security agency designated by the designated medical institutions of a selected Outpatient treatment of special diseases, and a year certain, need to change the designated medical institutions, with the original approval form to the social security agency to change the formalities; (5), recognized as eligible for outpatient treatment of special diseases of the insured, in the selected designated medical institutions for treatment or medication is the integrated fund of the medical expenses paid by the designated medical institutions and social security agencies to settle the medical costs, is a personal out-of-pocket medical expenses, the participants with the social security agencies to settle the medical costs, is a personal out-of-pocket medical expenses, the participants with the social security agencies, and the medical costs, is a personal out-of-pocket medical expenses, is a personal out-of-pocket medical expenses, is a personal out-of-pocket medical expenses. The medical expenses paid by the individual are settled between the insured person and the designated medical institution. 4. Reimbursement for medical treatment in other places If a participant seeks medical treatment in a medical institution in a different place, after advancing all the hospitalization expenses, the participant shall provide the following information to the Residential Insurance Section of the Municipal Social Insurance Bureau or the social security offices of the districts for reimbursement according to the regulations: a social security card, a form for approval of referral from a different place, a hospitalization invoice, the first page of the hospitalization and the hospitalization summary summary of the hospitalization expenses, a copy of the reimbursement passbook (account number), and a copy of the birth certificate if the child is born, and the birth certificate for the maternity service. In the case of hospitalization and delivery, the original and a copy of the birth certificate and birth certificate must also be provided, and other relevant information. (The information provided by the hospital need to be stamped with the hospital seal)Two, Hainan medical insurance reimbursement ratio and related policiesReimbursement ratio1, employees basic medical insurance.
Participants in a medical insurance year hospitalization starting line: 800 yuan in service, 600 yuan for retirement; three medical institutions reimbursement rate of 85%, two medical institutions reimbursement rate of 88%, a first-class or other medical institutions reimbursement rate of 90%. Retirees are paid 90% by the integrated fund and 10% by the individual. However, the following conditions must be met:1 receive a monthly pension in Hainan Province, 2 have participated in the basic medical insurance while in service, 3 years of contributions (including deemed) men over 30 years, women over 25 years. (Contributory years not reached, each year of reduction, its enjoyment of basic medical insurance benefits correspondingly reduced by 3%). 2, urban residents medical insurance. Participants in a medical insurance year hospitalization starting line for and reimbursement rate is: third-class medical institutions 350 yuan, reimbursement rate of 65%; second-class medical institutions 300 yuan, reimbursement rate of 75%; first-class or other medical institutions 100 yuan, reimbursement rate of 90%. 3. New rural cooperative medical care. Participants in a medical insurance year hospitalization starting line for and reimbursement rate for: third-level medical institutions 800 yuan, reimbursement rate of 60%; provincial second-level medical institutions 600 yuan, reimbursement rate of 65%; city and county second-level medical institutions 300 yuan, reimbursement rate of 75%; township-level medical institutions zero start reimbursement, ≤ 200 yuan reimbursement of 60%, > 200 yuan reimbursement of 90%.