It is possible to get reimbursed for out-of-pocket expenses that have not been filed.
It is possible to get reimbursed for out-of-pocket expenses, but you need to pay for the medical expenses first, and then go back to the place of insurance for reimbursement, and the reimbursement rate is less than that before the filing, and you can only be reimbursed for a portion of the expenses.
The record can be filed with the social security center at the district and county level where the medical insurance is located, and the employee medical insurance is based on the place of work, so bring your ID card and social security card, fill out the "registration form for medical treatment in a different place", and then you can directly settle the medical insurance in the designated hospitals after the record is filed.
Who needs to file a medical insurance claim?
(1)Retired persons resettled in a different place: persons who have settled in a different place after retirement and whose household registration has been moved to the place of settlement;
(2)Long-term residents in a different place: persons who have lived in a different place and have resided in the place for more than one year;
(3)Resident staff members in a different place: staff members who are assigned to work in a different place by their employing units, and who have a fixed residence and have worked in a different place for more than one year.
(4)Referrals from other places: those who need to be referred to overseas medical institutions for diagnosis and treatment due to their medical conditions by the designated medical institutions in the place where they are insured.
The first three categories are collectively referred to as "persons residing abroad".
How do I file a medical insurance claim?
1. People residing in other places
With their social security card and second-generation ID card, they can go to the medical insurance agency in the place where they are insured to apply for the registration of medical treatment in other places (if they are already residing in other places, they can delegate someone else to do the filing).
(1)Fill in the Basic Medical Insurance Registration Form (downloadable from the Zhengzhou Social Insurance Bureau website);
(2)Check whether the hospital for the record is on the list of fixed-point medical institutions for direct settlement of hospitalization fees networked for medical treatment in a different place. (The list of designated medical institutions, you can click: query)
(3) Participating medical insurance agencies to check, and upload the participant's information to the platform for settlement of medical treatment in a different place.
2.Transferring to other places for medical treatment
The first step is to choose a hospital (priority should be given to the designated medical institutions for direct settlement of hospitalization fees for medical treatment in other places).
The second step is for the insured person to bring his/her social security card, his/her ID card (the person acting on his/her behalf should bring the ID card of the person acting on his/her behalf), and the "Basic Medical Insurance Referral Form for Record of Medical Treatment" issued by the designated medical institution in the city that has the qualification of referral, and then go to the medical insurance agency in the place where he/she participates in the insurance to go through the formalities.
The third step is that the medical insurance agency of the insured place will check and upload the information of the insured person to the settlement platform for medical treatment in other places.
Materials required for the filing of off-site reimbursement for medical insurance
I. The following materials are required for off-site reimbursement (off-site filing, transferring to other places for medical treatment, etc.)
1. medical insurance card;
2. bank card;
3. original ID card of the person himself or the person who acted on his behalf;
4. invoice;
5. summary list;
6. Discharge summary or medical record.
2. Special reimbursement in addition to the above normal materials, but also need to provide the following materials
1. Business trip emergency: provide the unit stamped business trip certificate.
2. Chronic disease maintenance: medical records or discharge summary of chronic disease medication (Xiamen) and field certificates.
3. Newborns: birth certificate (within three months of birth to participate in the insurance).
4. Visiting relatives in other places: proof of visiting relatives (stamped by neighborhood committee, unit or other organizations).
5. Going out for personal use: proof of round-trip real-name air ticket and train ticket (copy can be provided).
6. Student vacation medical treatment in a different place: a certificate issued by the school and stamped.
7. Traffic accidents: public security or traffic police issued a certificate of responsibility and the situation (accidents to write a statement of circumstances).