One of the conditions for reimbursement
Zhejiang medical insurance participants in a different place, need to meet certain conditions to enjoy reimbursement treatment. Usually, the insured person needs to go through the record procedure in advance in the health insurance department for medical treatment in other places, and can enjoy the direct settlement service for medical treatment in other places only after the record is filed. In addition, the hospitals for medical treatment in other places should be designated medical institutions for medical insurance, and medical expenses incurred in non-designated medical institutions are generally not reimbursed.
The process of reimbursement for medical expenses incurred in other places
1. For the record of medical expenses incurred in other places: the insured person should go to the medical insurance department of the place where he/she is insured or the designated medical institution to apply for the record of medical expenses incurred in other places, and submit relevant materials and fill in the record form. After successful filing, the insured person can enjoy the direct settlement service for medical treatment in other places within the validity period of the filing.
2. Settlement of medical treatment: When the insured person seeks medical treatment in a different place, he should bring valid documents such as social security card or electronic voucher of medical insurance, and go through the admission procedures in the designated medical institution of medical insurance. When discharged from the hospital, the medical institution will directly settle the medical expenses, and the insured person only needs to pay the part of personal burden.
3. Reimbursement application: For medical expenses that cannot be settled directly, the insured person should bring relevant materials (such as medical invoices, diagnostic certificates, prescriptions, etc.) back to the medical insurance department of the place where he/she is insured to apply for reimbursement. The medical insurance department will review the reimbursement amount according to the policy and credit the reimbursement to the bank account designated by the participant.
Third, note
1. Participants should understand the policy of medical treatment in other places in advance, and ensure that the filing procedures are completed before medical treatment.
2. When seeking medical treatment in other places, participants should choose designated medical institutions to avoid incurring unreimbursable medical expenses.
3. Participants should keep the invoices of medical expenses, diagnostic certificates and other related materials for reimbursement.
In summary:
Zhejiang medical insurance can be reimbursed, but participants need to meet certain conditions and follow the relevant procedures. Before the foreign medical treatment, the insured person should go through the filing procedures in advance, choose the medical insurance designated medical institutions for medical treatment, and keep the relevant materials for reimbursement. The medical insurance department will review the reimbursement amount according to the policy and provide convenient reimbursement services for the insured.
Legal basis:
The Social Insurance Law of the People's Republic of China
Article 29 stipulates that:
The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly by the social insurance agency with the medical institutions and the drug business units.
The administrative departments of social insurance and the administrative departments of health shall set up a system for settling medical expenses for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
Zhejiang Provincial Medical Security Regulations
Article 20 stipulates:
After filing in accordance with the provisions of the insured persons, the medical expenses incurred for medical treatment in designated medical institutions for medical treatment in a different place can be directly settled through the basic medical insurance fund.