Social health insurance reimbursement is reimbursed after discharge or transfer.
Settlement procedures for hospitalization and outpatient treatment of special diseases:
The designated medical institutions will report the cost statement of patients discharged from hospitals in the previous month, hospitalization statement and relevant information to the medical insurance agency before the 10th day of each month, which will be used as the basis for the monthly preallocation and year-end final account after examination and approval;
The medical insurance agency will preallocate the monthly hospitalization and outpatient treatment costs for the previous month;
The medical insurance agency will preallocate the monthly hospitalization and outpatient treatment costs for the previous month.
Participants who are recognized as suffering from special diseases should go to a designated medical institution designated by the labor security department for medical treatment and purchase of medicines, and the medical expenses incurred will be recorded directly and settled instantly;
Emergency Settlement Procedure: medical expenses incurred by participants who are hospitalized in non-designated medical institutions in the city or in medical institutions in other places for emergency treatment will first be advanced by the individual or the unit and then paid by the individual or the unit.
Settlement procedures for staff resettled in other places:
The staff resettled in other places shall be assigned 1-2 designated medical institutions in their place of residence by their units and report to the medical insurance agency for the record;
Medical expenses incurred by the staff resettled in other places who are sick in designated medical institutions in their place of residence shall be advanced by themselves or by their units, and the medical expenses incurred by the staff resettled in other places shall be paid by themselves or by their units in advance and shall be paid by their units with a certificate of medical fees and charges of the insured person at the hospitals.
The medical expenses incurred by a staff member residing in a foreign country who is ill at a designated medical institution shall be paid in advance by the staff member or his/her unit, and after the treatment is completed, the medical expenses shall be settled by his/her unit with the staff member's medical certificate and medical records, valid expense bills, duplicate prescriptions, and list of hospitalization expenses, etc., on the specified date at the social medical insurance agency.
Referral and transfer settlement:
If the insured person is referred to other medical institutions for diagnosis and treatment due to the limitations of the designated medical institutions or due to specialized diseases, he/she has to fill in the approval form for referral and transfer. By the attending physician to put forward the reasons for referral and transfer, the department director to put forward the referral and transfer opinions, the medical insurance office of the medical institution audit, the signature of the dean in charge, reported to the Municipal Medical Insurance Center for approval before transfer;
The referral and transfer of hospitals, in principle, first in the city and then out of the city, the first in the province and then out of the province. Intra-city referrals and transfers are to be made between designated medical institutions. Out-of-town referrals and transfers must be made by the city's designated medical institutions above the third level;
The medical expenses incurred by the participant after the referral and transfer to the hospital shall be advanced in cash by the individual or the unit, and after the completion of the medical treatment, the participant or his/her representative shall reimburse the hospitalization expenses that belong to the scope of payment of the integrated fund to the medical insurance agency with the approval form for the referral and transfer to the hospital, the medical record certificate, the prescriptions and the valid documents.