With the improvement of living standard, more and more people participate in urban workers' medical insurance and want to benefit from it. However, although the urban workers' medical insurance serves the people, its urban workers' medical insurance reimbursement also has a certain scope. So, what is the scope of urban workers' medical insurance reimbursement? Below you will go along with this article to understand it!
What is the scope of urban workers' medical insurance reimbursement
Not to pay for the cost of urban workers' medical insurance reimbursement scope are: registration fees, out-of-hospital consultation fees, casework fees, clinic fees, expedited fees and so on. There are also some non-disease treatment programs are not reimbursed. For example, all kinds of cosmetic surgery, including weight loss, health care type of treatment programs. There are also a variety of medical consultations, medical appraisal is also outside the scope of medical reimbursement. In the case of Ms. Li, who wanted to undergo eye surgery at a cosmetic hospital, the treatment was voluntary rather than passive, and was non-disease treatment, so the cost was not reimbursed.
There is also no reimbursement for the use of large-scale medical equipment such as positron emission tomography (PET) scanners, electron-beam CTs, and laser therapies, which are not reimbursable. When using rehabilitation devices such as eyeglasses, dental prostheses and hearing aids, the costs are also not reimbursed. There is a Mr. Li who chose an eye hospital and wanted to have myopia surgery. Mr. Li's kind of surgery is not covered by the reimbursement. Another woman, Ms. Zhang, died of blood loss during a facial cosmetic surgery. Her family approached the health insurance organization for compensation and reimbursement, but the organization would not reimburse her because the surgery she underwent was a cosmetic surgery, which is a non-disease treatment, and it is clearly stated in the terms and conditions of the insurance policy that the cost of such treatments as well as the post-operative costs are not reimbursed by the health insurance organization. The insurance terms and conditions clearly stipulate that the costs of such treatment programs and post-operative costs are not covered by medical insurance. Therefore, the compensation claimed by Ms. Zhang's family is not protected by law.
City workers' health insurance reimbursement process
Through the above introduction, we know the city workers' health insurance reimbursement scope? Then, what is the process of reimbursement for urban workers' medical insurance? Urban workers medical insurance reimbursement is generally divided into two departments: outpatient reimbursement and hospitalization reimbursement. But I need to remind here is due to different areas of social security policy is very different, so the specific details of the reimbursement process varies from place to place, the following content is only to provide you with a reference, but each area is similar, please consult the local social security department for details. For the health insurance reimbursement strategy, I happen to organize the relevant content, I hope to help you: social security health insurance how to use? An article to teach you to apply for the reimbursement process!
First of all, let's talk about outpatient reimbursement. Urban workers health insurance reimbursement process is the most critical is the preparation of the declaration of information, information is missing. The materials to be prepared include: the original ID card or social security card; the original certificate of diagnosis of disease issued by the specialist doctor of the third or second level hospital of the designated medical institution; outpatient medical records, examination, test results report card and other original medical information; the original receipt of the outpatient charges of the financial and tax unified medical institutions; the original computer-printed list of outpatient expenses of the hospital or the original payment of the doctor's prescription; the designated drugstore: The original tax uniform invoice for commodity sales and the original computer-printed list; and the original ID card of the agent if it is done on behalf of the agent. After collecting all the information, go to the relevant department of the local social security center to apply for processing. If the information is complete and meets the conditions, it will be processed instantly.
There is also a process of reimbursement of urban workers' medical insurance for hospitalization, and the materials required are similar to those for outpatient reimbursement. Here is a special reminder: the insured person's condition requires referral (hospital), must be diagnosed by the designated medical institution (three or more) deputy chief physician or department head to put forward the referral (hospital) opinion, the unit to fill in the application form, by the designated medical insurance management department of medical insurance agreed to report to the city (district) social security institutions for approval after the referral (hospital) formalities. The transfer is limited to the provincial special hospitals, the cost of which is first paid by the person, and its reimbursement rate should be 10% of the first self-payment, and then calculate the amount of reimbursement in accordance with local regulations.
In short, all the insured should figure out the scope of reimbursement of urban workers' medical insurance to avoid unnecessary compensation disputes.