First, understand the medical insurance policy
First of all, we should understand the local medical insurance policy, including what medical services are covered by medical insurance, reimbursement ratio and limit. This information can usually be obtained through the official website of the local medical insurance department, service hotline or related publicity materials.
Second, query the qualifications of medical institutions
Before the planned inspection, you can inquire whether the medical institution has the qualification of medical insurance settlement. Public hospitals usually have such qualifications, while private medical institutions need cooperation or application to obtain them. Confirmation can be made through official website of medical institution, service window or telephone consultation.
Third, understand whether the inspection items are included in medical insurance.
Different inspection items may have different reimbursement policies. Some common examination items, such as blood routine and urine routine, are usually included in the scope of medical insurance. However, some special inspection items, such as some high-end imaging or laboratory tests, may not be reimbursed by medical insurance. Therefore, when planning the inspection, you need to know the reimbursement of specific projects.
Four, for medical insurance settlement procedures
If the medical institutions and inspection items meet the conditions of medical insurance settlement, you need to bring a valid medical insurance card and identity certificate when you seek medical treatment, and go through the medical insurance settlement procedures according to the requirements of medical institutions. Usually, medical institutions will automatically deduct the medical insurance part when charging, and individuals only need to pay the rest.
Five, pay attention to the individual pays part.
Even if the inspection items are included in the scope of medical insurance, some of them may be paid by individuals themselves. This includes some expenses that are not covered by medical insurance, such as some medicines and consumables. Therefore, it is necessary to understand and prepare the self-funded part that may need to be paid when seeking medical treatment.
To sum up:
Whether the medical insurance card can be swiped mainly depends on whether the medical service items and medical institutions are included in the medical insurance settlement system. Before seeking medical treatment, you should know the medical insurance policy, inquire about the qualifications of medical institutions, understand the reimbursement of inspection items, and prepare the individual pays part. Through these steps, we can make full use of the medical insurance policy and reduce the economic burden in the process of medical treatment.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28 provides that:
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 30 provides that:
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.