Medical insurance is divided into many kinds, there are employees' medical insurance, residents' medical insurance and so on, different kinds of medical insurance, corresponding to the medical insurance reimbursement procedures are not the same.
Documents and information needed for medical insurance claims:
(1)Methods of reimbursement to local designated hospitals for residents' medical insurance
1. Within three days of the patient's admission to the hospital, the patient can go to the medical insurance office of the designated hospital where he/she lives with his/her Admission Notice and Medical Insurance Card to go through the procedures of registering for medical insurance. During the hospitalization, the medical insurance card will be kept by the hospital medical insurance office and returned to the patient when he/she is discharged from the hospital.
If you do not go through the registration procedure for more than three days, you will be responsible for your own hospitalization medical fees.
2. When you are discharged from the hospital, you should first go to the hospital medical insurance office to go through the medical insurance discharge settlement procedures.
3. If the insured residents pay the medical insurance premiums in full and on time, the hospital will directly settle the reimbursement of the medical expenses paid by the medical insurance fund when the patient is discharged from the hospital.
(2) Reimbursement method of referral
1, residents who really need to be transferred to hospitalization outside the city, the city's central people's hospital or Chinese medicine hospitals need to put forward the opinion of the transfer, the director of the department signed and agreed to report to the municipal health insurance agency for approval before the transfer of hospitalization to public medical institutions in foreign countries, without approval of the transfer of their own hospitalization abroad, the medical costs at their own expense.
2, the transfer of medical expenses by the medical insurance agency to accept reimbursement, you need to provide the following materials: (1) transfer approval form; (2) a complete copy of the hospitalization medical records (stamped); (3) the original invoice (stamped); (4) a summary list (stamped); (5) medical insurance card.
(C) reimbursement methods for relocation
1, the registration procedures for the record: in the field of continuous residence for more than one year of health insurance enrollees, you can go to the Medical Management Section to get the "relocation of personnel living in a different place of health insurance registration form" (in triplicate), mailed to the person who resides in a different place of residence by the enrollees to independently choose their place of residence, three public hospitals as a fixed-point hospital (respectively, one, two, three), fill in the content of the hospital, and then send it to the person who resides in a different place of residence, and the person who lives in a different place of residence can choose his own choice. The insured person independently chooses three public hospitals as designated hospitals in his/her place of residence (first, second and third level, respectively), fills in the content completely, confirms it with the seal of the Medical Insurance Office, and then submits it to the Medical Management Section for examination and approval, and then enters it into the medical insurance system for record. It is also necessary to provide a copy of the real estate license or proof of residence in the other place.
2, the reimbursement method: the relocation of medical expenses by the medical insurance business reimbursement, reimbursement of the required information include: (1) a complete copy of hospitalization records (stamped); (2) the original invoice (stamped); (3) a summary list (stamped); (4) health insurance manual; (5) my ID card. Hospitalization expenses for the current year will be accepted from November to February each year, and reimbursement will be centralized at the beginning of the following year. Inter-year hospitalization expenses will not be accepted.
(D) business trip, visiting relatives reimbursement method
1, the insured person due to business trip, visiting relatives in foreign health insurance designated hospitals due to emergency rescue hospitalization, need to be hospitalized within three working days after the patient or family members to inform Tengzhou City Health Insurance Office for the record. Failure to register for the record is responsible for the cost.
2, for reimbursement must be carried by the person himself to the medical insurance office for the following information.
(1) the participant's unit (village, neighborhood committee) certificate;
(2) business trip or visiting party's proof of residence;
(3) the medical bills for this hospitalization;
(4) the hospitalization of the emergency diagnosis certificate (must be stamped with the hospital's official seal);
(5) hospitalization medical records contain a copy of the first page of the hospitalization, hospitalization records, discharge summary, long and short-term hospitalization.
(6)Summary of hospitalization expenses (all of the above information must be stamped with the hospital seal);
(7)A copy of the patient's own health insurance card and ID card.
(E) Reimbursement of Community Outpatient Medical Expenses
Participating residents holding the Resident Medical Insurance Card go to the designated community station (center) for outpatient medical treatment, and the outpatient medical expenses incurred will be settled and reimbursed instantly by the attending community service station (center).
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