Employee health insurance reimbursement process:
(A) Resident health insurance local fixed hospital reimbursement method
1, the patient was admitted to the hospital within three days of the "admission notice" and "medical insurance card" to the hospital hospital medical insurance office of the fixed hospital where you live to apply for the medical insurance registration procedures. During the hospitalization, the medical insurance card will be kept by the medical insurance office of the hospital and returned to the patient when he/she is discharged from the hospital.
If you do not go through the registration procedure for more than three days, you will be responsible for your own hospitalization medical fees.
2. When you are discharged from the hospital, you should first go to the hospital medical insurance office to go through the medical insurance discharge settlement procedures.
3. If the insured residents pay the medical insurance premiums in full and on time, the hospital will directly settle the reimbursement of the medical expenses paid by the medical insurance fund when the patient is discharged from the hospital.
(2) Reimbursement method of referral
1, residents who really need to be transferred to hospitalization outside the city, the city's central people's hospital or Chinese medicine hospitals need to put forward the opinion of the transfer, the director of the department signed and agreed to report to the municipal health insurance agency for approval before the transfer of hospitalization to public medical institutions in foreign countries, without approval of the transfer of their own hospitalization abroad, the medical costs at their own expense.
2, the transfer of medical expenses by the medical insurance agency to accept reimbursement, need to provide the following materials:
(1) transfer approval form;
(2) a complete copy of the hospitalization medical records (stamped);
(3) the original invoice (stamped);
(4) a summary list (stamped);
(5) medical insurance certificate .
(3) Reimbursement Methods for Relocation
1. Registration Procedures: Health insurance participants who have resided in a foreign country for more than one year continuously can go to the Medical Management Section to get the "Registration Form for Health Insurance for Personnel Residing in a Foreign Country" (in triplicate), which will be mailed to the person who resides in a foreign country, and the participant will independently choose three public hospitals in the area where he resides as the fixed-point hospitals (respectively, the first, second and third level), fill in the contents, and then send it to the person who resides in the foreign country for reimbursement.
2. The insured person independently chooses three public hospitals in his/her place of residence as the designated hospitals (first, second and third level respectively), fills in the content completely, confirms it with the seal of the Medical Insurance Office, and then submits it to the Medical Management Section for examination and recording in the medical insurance system. It is also necessary to provide a copy of the real estate license or proof of residence in the other place.
2, reimbursement method: the relocation of personnel medical expenses by the Medical Insurance Business Office for reimbursement, reimbursement of the required information include:
(1) a complete copy of hospitalization records (stamped);
(2) the original invoices (stamped);
(3) a summary list (stamped);
(4) medical insurance manual;
p>(5)My ID card. Hospitalization expenses for the current year will be accepted from November-February each year, and reimbursement will be centralized at the beginning of the following year. Inter-year hospitalization expenses will not be accepted.
(D) business trip, visiting relatives reimbursement method
1, participants due to business trips, visiting relatives in foreign health insurance designated hospitals due to emergency rescue hospitalization, need to be hospitalized within three working days after the patient or family members to inform the Tengzhou City Health Insurance Office for the record. Failure to register for the record is responsible for the cost.
2, for reimbursement must be carried by the person himself to the medical insurance office for the following information.
(1) the participant's unit (village, neighborhood committee) certificate;
(2) business trip or visiting party's proof of residence;
(3) the medical bills for this hospitalization;
(4) the hospitalization of the emergency diagnosis certificate (must be stamped with the hospital's official seal);
(5) hospitalization medical records contain a copy of the first page of the hospitalization, the hospitalization record
(6)Summary of hospitalization expenses (all of the above information must be stamped with the hospital seal);
(7)A copy of the patient's own health insurance card and ID card.
(E) Reimbursement of Community Outpatient Medical Expenses
Participating residents holding the Resident Medical Insurance Card go to the designated community station (center) for outpatient medical treatment, and the outpatient medical expenses incurred will be settled and reimbursed instantly by the community service station (center) where they receive medical treatment.
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