The medical expenses of the insured who died after emergency rescue, the medical expenses during emergency observation and hospitalization observation, and the medical expenses of the insured for emergency treatment of approved diseases in outpatient department are not included in the overall payment scope of ordinary outpatient department.
Emergency medical insurance reimbursement scope:
Stay in the emergency observation room of the hospital to observe the following symptoms: acute severe trauma, brain trauma, fracture, dislocation, laceration, burn, sudden acute abdominal pain, sudden high fever, sudden bleeding, hematemesis, internal bleeding symptoms, diarrhea, severe dehydration, shock, convulsion or coma, foreign bodies in ears, nose, throat, eyes, trachea, bronchus and esophagus, acute eye pain, redness or acute visual impairment, etc. Poisoning, drowning, electric shock, acute urinary incontinence, acute allergic diseases, suspected severe infectious diseases and other people who are considered life-threatening by the attending physician or above should be rescued urgently.
What are the reimbursement procedures for emergency medical insurance?
The insured person holds the diagnosis and treatment manual, emergency invoice, emergency medical record and discharge certificate (or copy of death certificate) to go through the reimbursement procedures in the medical insurance department of the designated hospital where the emergency occurred, and fill in the emergency reimbursement application form.
It is suggested that the medical expenses incurred by the insured who died after emergency rescue, the medical expenses incurred during emergency observation and hospitalization observation, and the medical expenses incurred by the insured in the outpatient emergency treatment approved diseases should not be included in the scope of general outpatient co-ordination payment.
Proportion of medical insurance reimbursement:
1. Emergency medical expenses: the medical expenses that meet the requirements of the employee's basic medical insurance year (1 October 1 day 1 February 3 1 day1day) exceed 2,000 yuan.
2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan.
3. The insured shall properly keep the outpatient medical documents (including receipts and prescriptions below a large amount) in the designated hospitals as medical expense reimbursement vouchers.
How to reimburse
1. Direct reimbursement of medical insurance card: If I take my medical insurance card with me when I see a doctor, I can directly bind the medical insurance system. When the hospital calculates and pays the expenses, it can settle the medical insurance in real time, and we only need to pay the corresponding expenses after deduction.
2. Offline reimbursement: If you don't bring your social security card when you see a doctor, you can only make offline reimbursement after seeing a doctor. Generally, you can take offline insurance. Users hold hospital payment invoices, medical records, doctor's advice certificates and other materials to the local social security center, fill in the information as required and submit it. After approval, the reimbursement amount will be automatically allocated to the bank card account bound by medical insurance.
legal ground
People's Republic of China (PRC) social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.