Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. I hope it will help everyone. First, residents' medical insurance reimbursement process After the insured patients are discharged from the hospital, they need to submit to the community a receipt of hospitalization expenses, a copy of the first page of medical records (stamped with the seal of the medical insurance department of the hospital), a discharge summary, a discharge certificate, a detailed list of hospitalization expenses (one-day list), a copy of medical insurance cash payment form and a copy of ID card for relevant registration before/kloc-0. And before the 5th day of each month, the communities will report the relevant materials and lists to the district medical insurance office; From 5th to 10 every month, the district medical insurance office will review the relevant bills and calculate the reimbursement amount; After that, every month from 12 to 15, the district medical insurance office will report to the municipal medical insurance center for approval; In the first ten days of the following month, the district medical insurance office pays the reimbursement expenses. Insured patients with my ID card to the district medical insurance office to receive. Second, how to deal with the lack of medical insurance payment period? The Notice on Issues Related to the Payment and Treatment of Employees' Basic Medical Insurance clarifies that when the insured reaches the statutory retirement age, the cumulative payment period of medical insurance premiums is not less than 25 years for men and 20 years for women, and the actual payment period in this city is not less than 5 years. After retirement, medical insurance premiums will no longer be paid, but large medical assistance payments in the current year should be paid according to regulations, and medical expenses incurred will be reimbursed according to regulations. When the insured reaches the statutory retirement age, if the accumulated payment of medical insurance premiums is less than the prescribed number of years, they can make up the medical insurance premiums payable by units and individuals at one time according to the difference between the payment standards and the number of years in the current year when going through retirement procedures. For those who have gone through the retirement formalities, if they can't enjoy the medical insurance treatment temporarily due to insufficient payment period, they can also make up the difference at one time according to the regulations, and make up the medical expenses incurred from that month according to the regulations. Among them: the retirees of the unit make up the difference of years according to the payment method of unit insurance at the time of payment and the average monthly salary of employees in this city in the previous year; Individual insured retirees make up the difference in the number of years, and shall be handled according to the payment base of the current year specified by the individual insured. Three. How to pay the medical insurance premium (1) The collection department of the medical insurance institution accepts the Declaration Form for the Change of Medical Insurance Payment Base filled out by the insured unit, and requires the following information: 1, other information specified by the medical insurance institution. 2. Wage payment schedule; 3. List of increase or decrease of medical insurance personnel (II) Payment verification 1. The collection and payment department of medical insurance institutions shall review the payment declaration checklist and related materials reported by the insured units. After passing the examination, the insured shall go through the formalities of approval or increase or decrease. 2. The collection department of the medical insurance institution shall, according to the declaration and verification of payment, record the time of enrollment and the current payment of wages and other information for the newly-added insured personnel in a timely manner. The collection and payment department of the medical insurance institution shall declare and approve the current payment base according to the insured unit. 3. The collection and payment department of the medical insurance institution shall calculate the payable amount according to the approved current payment base and payment rate of the insured unit, print the Notice of Medical Insurance Payment, and feed it back to the reporting unit for collection and payment on this basis. (3) Charge 1. Medical insurance institutions can collect fees through the "income household deposit" bank, or by cheque, cash, wire transfer, cashier's check, etc. , and issue a special receipt. The financial management department of the medical insurance institution reconciles with the bank every month and feeds back the receipt to the collection department. 2. The collection and payment department of medical insurance institutions shall, according to the payment of medical insurance premiums fed back by the financial management department, issue a "Social Insurance Premium Reminder Notice" to the insured units that fail to pay medical insurance premiums in full and on time after the declaration. If it is not implemented within the time limit, it shall provide relevant information and materials to the administrative department of labor security, which shall make corrections within a time limit. 3. Before 25th of each month, if the insured unit fails to pay the fee, a late fee of 2‰ will be charged on a daily basis from the date of default. It can be paid in one lump sum for one month, one quarter, six months or one year. If it is paid quarterly or annually, it should be paid at the beginning of the quarter or the beginning of the year. Temporarily unable to pay, you can apply for holdover, holdover time shall not exceed 2 months. (iv) Payment of arrears 1. The insured unit shall pay the arrears according to the Notice of Payment of Social Insurance Fees or the payment agreement, and the collection department of the medical insurance institution shall accept it and notify the financial management department of the medical insurance institution to collect it. 2. If the bankrupt unit can't pay off the arrears in full, the collection department of the medical insurance institution accepts the application made by the bankruptcy liquidation group of the unit and sends it to the auditing and supervision department for handling. 3. The collection department of the medical insurance institution shall adjust the arrears information of the insured unit according to the overdue arrears information of the financial management department and the verification information of the audit supervision department. 4. The collection and payment department of medical insurance institutions shall, according to the arrears of medical insurance, establish arrears data information, fill in the Notice on Payment of Social Insurance Fees, and notify the insured units to pay arrears. 5, due to financing difficulties, unable to fully pay off the arrears of the insured units, by the medical insurance institutions and the collection department signed a social insurance payment agreement. In the case of merger, division, bankruptcy, etc. For defaulting units, overdue agreements shall be signed in the following ways. (1) If the defaulting units are merged, a payment agreement shall be signed with the merging party. (2) If the arrears unit is separated, it shall sign a payment agreement with each branch. (3) If the defaulting unit enters bankruptcy proceedings, it shall sign a settlement agreement with the liquidation group. (4) If the unit sells or rents by auction, it shall sign a payment agreement with the competent department. The above is the whole content of this article. I hope it will help you and answer your questions. They are online 24 hours a day and can answer your legal questions at any time.
Legal objectivity:
Article 28 of the Social Insurance Law conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid by the basic medical insurance fund in accordance with state regulations.