Under special circumstances, even if a participant is not hospitalized in a designated hospital, he or she can still apply for reimbursement under the health insurance. These circumstances include: the technical and equipment limitations of the designated medical institutions, which make it impossible to carry out the necessary diagnosis and treatment, or the condition requires referral to a non-designated medical institution; and the participant's inability to go to the designated hospital in time to receive treatment due to the critical condition of the participant, such as acute myocardial infarction, cerebral infarction, cerebral hemorrhage, acute traumatic injuries, acute intoxication, acute abdominal diseases and other emergencies. In these cases, if hospitalized in a non-designated hospital (including off-site hospitals), the insured person can report to the health insurance center within five working days after hospitalization for expense reimbursement.
Social security reimbursement rules:
1. Reimbursement conditions: need to meet the reimbursement conditions stipulated in the social security policy, such as the identity of the insured person, payment status, medical procedures, etc.
2. Scope of medical treatment: usually required to be in the designated medical institutions in order to enjoy the reimbursement of social security;
3. Reimbursement rate: different medical services and medicines have different reimbursement rates, usually based on the social security policy, and the reimbursement rate for different medical services and medicines.
3. Reimbursement rates: Different medical services and medicines have different reimbursement rates, which are usually based on the social security policy and the individual's social security class;
4. Reimbursement process: Reimbursement needs to be made by submitting the relevant medical expense vouchers, diagnostic certificates and other documents, and in accordance with the stipulated procedures;
5.
In summary, under special circumstances, even if the insured person is not hospitalized in a designated hospital, he can be hospitalized in a non-designated hospital and declare to the health insurance center within five working days after the hospitalization in order to reimburse the expenses.
Legal basis:
The Law of the People's Republic of China on Social Insurance
Article 28
Medical expenses that are in accordance with the drug list, diagnostic and therapeutic items, and standards of medical service facilities of the basic medical insurance as well as those of the emergency and rescue shall be paid out of the basic medical insurance fund in accordance with the state regulations.