1. Emergency medical expenses incurred by a participant at a designated health insurance institution will be reimbursed after examination and approval by the health insurance management department of the designated health insurance institution and will be included in the general outpatient settlement. However, if the participant's emergency medical expenses are incurred at a designated medical institution that is not a designated medical insurance institution for general outpatient coordination, the coordinated payment will not be paid. The medical expenses incurred by the participant who died in an emergency, the medical expenses incurred during the period of transferring from emergency observation to inpatient observation, and the medical expenses incurred by the participant of outpatient prescribed diseases for the emergency treatment of approved diseases are not included in the scope of payment of the general outpatient co-ordination.
I. Reimbursement amount 1. Outpatient and emergency medical expenses: refers to the part of the total medical expenses of the active employees that exceeds 2,000 yuan in the current year (January 1~December 31) in accordance with the basic medical insurance regulations. 2. 2. Example of settlement comparison method: 50% reimbursement and 50% personal payment for more than 2,000 RMB for dispatched staff during the contract period; the maximum amount of outpatient and emergency reimbursement paid to dispatched staff shall not exceed 20,000 RMB per year. 3. The insured person should keep the outpatient medical bills (including receipts and the bottom of prescriptions for the part below the large amount) properly in the designated hospital as proof of reimbursement of medical expenses. 4. outpatient treatment of three diseases: when the insured person needs to take anti-rejection drugs for malignant tumors after radiotherapy and chemotherapy, renal dialysis and kidney transplantation, the second and third of the insured person's designated hospitals to issue a "certificate of diagnosis of the disease" and fill out the application and approval of the form of special disease medical insurance, reported to the regional medical insurance center for approval and filing. Outpatient treatment and medication for these three special diseases are limited to the designated hospitals approved for treatment and cannot be purchased at designated retail pharmacies. Medical expenses incurred are settled with reference to hospitalization expenses if they are within the scope of outpatient special diseases.
: health insurance payment methods 1. urban workers and flexible workers health insurance payment methods: (1) asset payment: sign an agreement to entrust the bank transfer and payment of taxes and fees on behalf of the local tax and bank (hereinafter referred to as the ETS agreement), and to ensure that the ETS bank account is normal and fully prepared, and the account balance is greater than $1 after deducting expenses so as to pay the current expenses and historical amounts owed. (2) Invoicing and payment at the door: go to the tax office to issue a general tax completion certificate and pay the fee at the bank. 2. urban residents health insurance payment methods: (1) the first time insured: for those who deal with commissioned bank transfers and payments: sufficient funds should be prepared before the payment account on the 4th of the following month for the insurance registration and the account balance deducted expenses exceeding 1 yuan, should be automatically transferred and paid by the bank. If the commissioning bank fails to transfer the funds between the 4th and 23rd of the following month after the insurance registration, it should be processed as "unsuccessful transfer" at any business location of the collecting bank. (2) Renewal of insurance for the new social security year: For those who have already made a bank transfer: deposit sufficient funds in the payment account before August 4 of each year, with a balance of more than $1 after deduction of fees. The bank will automatically transfer the funds. If the delegated bank fails to transfer the funds between August 4 and 23 of each year, the payment will be made as an "unsuccessful transfer" at any business location of any collecting bank.