Medical insurance reimbursement flow chart:
Purchase of medicine medical insurance reimbursement notes:
Participants can hold a medical insurance card to purchase medicines in all designated medical institutions, designated retail pharmacies, the cost of their medicines can be directly settled by the card, the purchase of medicines are not counted as social coordination, all paid by the individual account, if the individual account gold is exhausted, you can pay in cash.
Outpatient medical insurance reimbursement process and notes:
Reimbursement need to bring the following information: 1. the original ID card or social security card; 2. the original diagnostic certificate of disease issued by the designated medical institution specialist doctor; 3. outpatient medical records, examination, test results report card and other original medical information; 4. financial, tax unified medical institutions outpatient fee receipts original; 5. hospitals The original computer-printed list of outpatient expenses or the original payment of the prescription issued by the doctor; 6. Designated pharmacies: the original unified invoice for the sale of tax commodities and the original computer-printed list; 7. If it is on behalf of a person to do so, you need to provide the original ID card of the person who will do it for him or her.
Bring all the above information to the local social security center relevant departments to apply for processing, after examination, the information is complete and meet the conditions, it can be instantly processed. When the applicant applies for reimbursement of outpatient medical expenses, the amount transferred to the individual account of medical insurance in the current social security year will be deducted first, and then the amount to be reimbursed will be approved.
Inpatient medical insurance reimbursement process and notes:
1. When you are admitted to or discharged from the hospital, you must go to the medical insurance management window of each designated medical institution with your medical insurance IC card to go through the registration procedures for entering and leaving the hospital. When you are hospitalized, you have to pay the medical fee deposit in advance, and then you have to pay more or less after you are discharged from the hospital. Medical fees incurred before hospitalization registration are not covered by basic medical insurance. If you are hospitalized due to an emergency and cannot complete the hospitalization registration procedures in time, you should go to the medical insurance management window on the next day after your admission to the hospital with a certificate of emergency to complete the hospitalization procedures (postponed in case of holidays), and you will be responsible for the medical fees incurred beyond the time limit.
2. The starting line of the integrated fund after hospitalization: the starting line varies from place to place and is generally 10% of the average annual salary of the city's employees in the previous year, and the medical fees for multiple hospitalizations are calculated cumulatively within a basic medical insurance settlement year.
3. If the insured person needs to be referred or transferred to another hospital due to his condition, he must be diagnosed by the deputy chief physician or the head of the department of the designated medical institution at or above the third level and then put forward the opinion of referral, and then his unit will fill in the application form, which will be reviewed and agreed by the management of the medical insurance department of the designated medical institution and reported to the municipal (district) social security institutions for approval to carry out the procedures of referral.
The transfer is limited to the provincial special hospitals, the cost of which is first advanced by the person, and its reimbursement rate should be 10% first, and then calculate the reimbursable amount in accordance with local regulations.
4. When discharged from a designated medical institution, each designated medical institution will calculate the amount of reimbursement and the amount that the individual should pay out of his own pocket in accordance with the relevant policies; the reimbursement amount will be settled between the designated medical institution and the municipal social insurance agency, while the amount that the individual should pay out of his own pocket will be settled between the designated medical institution and the insured person.
The reimbursement time for each kind of medical insurance is different, it is recommended that you can log on to the website of the local human resources and social security bureau to check the relevant policy regulations, or call 12333 to consult the local medical insurance reimbursement time.
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