1. The agent submits the reimbursement documents and other materials to the social security agency for acceptance;
2. After receiving the application materials, the accepting department shall review, settle accounts and pay;
3. If the social security agency approves the application, the applicant will be reimbursed after receiving the "Social Medical Insurance Medical Expense Reimbursement Form". When seeking medical treatment, show the medical insurance card to the designated hospital to prove the identity of the insured. At the time of checkout, the part paid by the individual is paid by medical insurance card or cash, and the part reimbursed by medical insurance is settled by medical insurance and hospital, so the individual does not need to pay first and then reimburse.
Scope and standard of medical insurance reimbursement:
1. Drugs are divided into Class A, Class B and Class C, among which Class A drugs are necessary for clinical treatment and widely used, and the drug expenses of these drugs are reimbursed according to the proportion stipulated by medical insurance. Class B drugs are paid a certain proportion first, and then reimbursed according to medical insurance. The specific reimbursement ratio varies from place to place.
2, diagnosis and treatment project refers to the hospitalization, the use of medical instruments, equipment and medical materials, mainly in two ways, the whole project is included in the scope of medical insurance reimbursement, according to the provisions of the proportion of payment. As a whole, part of the project is paid in advance, and then reimbursed according to the prescribed proportion;
3, medical service facilities standards, refers to the hospital bed fees, outpatient and emergency observation bed fees, etc., the scope and standards of reimbursement vary from place to place. In terms of social security, the scope of medical insurance reimbursement is the items in the medical insurance catalogue, including drugs, medical treatment items and medical services.
Stone.
Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC).
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.