1, medical insurance fund within the scope of the project: inpatient medical insurance fund within the scope of the project, you can enjoy reimbursement policy in accordance with the provisions of the medical insurance, the hospital shall not charge the patient out-of-pocket expenses;
2, non-medicare fund within the scope of the project: inpatient non-medicare fund within the scope of the project, you can choose to use at their own expense. Hospitals should clearly inform patients of the self-funded nature of the project, price and effect, patients can choose whether to use;
3, self-funded project management: hospitals should develop self-funded project use management system, clear self-funded project types and prices, standardize the use of self-funded project procedures and management processes. In the case of clearly informing the patient self-pay items, the hospital can charge the patient self-pay fees, and provide the appropriate services and protection;
4, self-pay program fees: hospitals should be in accordance with the relevant provisions of the self-pay program fees shall not be higher than the reasonable market price. At the same time should be publicized self-financed items of the charges and the use of social supervision.
Medicare reimbursement methods are as follows:
1, before seeking medical treatment: Before seeking medical treatment, you need to confirm the type and scope of your own medical insurance, and choose medical institutions and doctors in line with the medical insurance policy, in order to ensure that the medical expenses can be reimbursed;
2, the process of seeking medical treatment: in the process of seeking medical treatment, you need to accurately fill in the basic personal information and the situation of the clinic, and provide your medical card and relevant information to the doctors and medical institutions. Provide doctors and medical institutions with your health insurance card and relevant supporting materials;
3. Reimbursement application: After the end of the medical treatment, you need to submit the application for reimbursement of medical expenses to the local social insurance management center or medical insurance office, and provide relevant medical bills and supporting materials, such as outpatient invoices, prescription pads, medical records, etc.
4. Reimbursement audit: The medical insurance institutions will audit the application for reimbursement of medical expenses and check the expenses and the cost of the medical treatment;
4. The medical insurance organization reviews the application for reimbursement of medical expenses and checks information such as expenses and medical conditions to determine the reimbursement rate and amount;
5. Reimbursement Payment: After the review is approved, the medical insurance organization pays the reimbursement amount to the applicant's bank account or medical insurance card.
In summary, the reimbursement methods may vary in different regions and types of health insurance, and the specific reimbursement process needs to be operated according to local policies and regulations. In addition, when making reimbursement, you need to carefully check your health insurance information and medical expenses to avoid filling in incorrect or false information, so as not to affect the efficiency and accuracy of reimbursement.
Legal basis:
Article 23 of the Social Insurance Law of the People's Republic of China
Employees shall participate in the basic medical insurance for employees, and shall pay the basic medical insurance premiums by the employing unit and the employees in accordance with the state regulations***. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the State regulations.
Article 28
Medical expenses that conform to the basic medical insurance drug list, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergencies and rescues, shall be paid out of the basic medical insurance fund in accordance with the state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.