1. If it is not paid in time, the social medical insurance premiums payable by employees whose medical insurance cards are suspended must be paid in the current month, and they can enjoy medical insurance benefits only next month according to regulations. If the payment of social insurance premiums is stopped in the current month, the medical insurance bookkeeping function will be stopped or suspended from the following month 1.
2. Hospital-side system failure Sometimes there will be system failure when the hospital settles, so it can only be settled at its own expense first.
What are the conditions for medical insurance reimbursement?
1, the insured person must go to the designated medical institution of basic medical insurance or the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital;
2. The medical expenses incurred by the insured in the process of medical treatment must conform to the scope and payment standards of the basic medical insurance drug list, medical treatment items and medical service facilities standards, and can be paid by the basic medical insurance fund according to regulations;
3. The medical expenses incurred by the insured that meet the payment scope of basic medical insurance shall be paid by the social medical pooling fund in a unified proportion, with the expenses above the Qifubiaozhun and below the maximum payment limit.
What are the classifications of medical insurance?
1. Reimbursement medical insurance means that the medical expenses spent by patients in the hospital are reimbursed by insurance companies, which are generally divided into outpatient medical insurance and inpatient medical insurance;
2. Compensatory medical insurance refers to the fact that the patient is clearly diagnosed by the hospital as suffering from a certain disease listed in the contract, and the insurance company pays the patient's treatment and nursing expenses according to the amount agreed in the contract. Generally divided into single disease insurance and critical illness insurance;
3. Subsidized medical insurance is medical insurance in which the insurance company pays the insured the insurance money by time, by day or by project according to the subsidy standard stipulated in the contract. Claims have nothing to do with actual medical expenses, and invoices are not needed.
legal ground
People's Republic of China (PRC) insurance law
Tenth employees should participate in the basic old-age insurance, and employers and employees should pay the basic old-age insurance premium.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.
Forty-fourth employees should participate in unemployment insurance, and employers and employees should pay unemployment insurance premiums in accordance with state regulations.
Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.
Fifty-third employees should participate in maternity insurance, the employer should pay maternity insurance premiums in accordance with state regulations, and employees do not pay maternity insurance premiums.
Article 33 Employees shall participate in work-related injury insurance, and the employer shall pay the work-related injury insurance premium, while employees shall not pay the work-related injury insurance premium.