Place of medical treatment: the medical treatment must be provided at a designated medical institution within the city of Guangzhou.
Time of visit: The reimbursement of emergency medical expenses by GZMHI is limited to the expenses incurred on the same day of the visit, and if it exceeds the timeframe of the same day of the visit, then GZMHI will not be able to reimburse the expenses.
Provenance: In order to prove that a participant's emergency medical treatment was caused by a sudden illness or accidental injury, GZMIP requires the participant to provide relevant proof, such as emergency medical records and emergency prescriptions.
Additionally, participants of both the Employee Health Insurance and the Urban and Rural Residents' Health Insurance are entitled to reimbursement of basic medical expenses for general outpatient care (including emergency care) in accordance with the regulations. The specific settlement method will be agreed upon by the municipal medical insurance agency in accordance with the stipulated standards and methods and the service agreement signed with the designated medical institutions.
Medicare reimbursement procedures:
1. When registering for hospitalization: you need to present your medical insurance card and ID card, and the hospital will check and verify the participant's personal information and contributions in the medical insurance information system, and handle the admission procedures for him/her.
2. During hospitalization: please remind the doctor that if you use self-paid medicines, diagnostic and therapeutic items and medical service facilities, the patient or his/her family members have to sign and agree.
3. Discharge: If the hospitalization treatment meets the criteria for discharge, the attending doctor will issue a discharge notice, and the participant will go to the discharge office with the discharge notice and medical insurance card to settle the bill. Discharged with medication, generally not more than 7 days of medication. When discharged from the hospital, the participant or his/her family members have to sign the "Guangzhou Medical Insurance Expense Settlement Statement" to confirm.
In summary, the insured person due to critical, emergency, serious illness in the medical insurance designated hospital emergency outpatient resuscitation failure of death, the employee health insurance in the emergency costs incurred in the designated hospital reimbursement, medical insurance reimbursement of 70%, the individual out-of-pocket payment of 30%; residents of the emergency outpatient costs of medical insurance by the counties (cities, districts) urban health insurance center audit and confirmation, the medical insurance reimbursement of 50%, the individual out-of-pocket payment of 50%.
Legal basis:
The Chinese People's **** and the State Social Insurance Law
Article 28
In line with the basic medical insurance drug directory, diagnostic and treatment items, medical services and facilities standards, as well as emergency and rescue medical expenses, in accordance with national regulations from the basic medical insurance fund.
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.