Participants medical expenses reimbursement process
Audit and review scope: (1) approved by the Municipal Health Insurance Center for the record transfer to out-of-town medical institutions hospitalization medical expenses incurred;
(2), foreign residence, work, in the place of residence, work in the designated health care institutions hospitalization, outpatient medical expenses incurred;
(3), for business trips, Visiting relatives, due to sudden illness, hospitalization in local public hospitals incurred medical expenses;
(4), enjoy part of the outpatient chronic disease outpatient subsidies, outpatient treatment, medication incurred medical expenses;
(5), the city designated medical institutions agreed by the Office of the Medical Insurance for outpatient special examinations incurred;
(6), agreed by the municipal health care center for special treatments incurred medical costs;
(6), the city health care center agreed to the outpatient special treatment;
(7), other medical expenses eligible for reimbursement.
Audit methods: (1) medical expenses incurred by the insured person hospitalized due to illness, within 10 days after the end of the medical treatment, he/she can bring his/her own medical insurance calendar, discharge summary, detailed list of expenses, hospitalization invoices, and copies of medical orders (for those who are on business trips, visiting relatives, the proof of the unit should be attached; those who are stationed in a different place should be attached to the form of declaration of medical treatment for the stationed in a different place; and those who have been transferred to a different hospital should be attached to the form of transfer of hospitalization application), and other audit materials to the Office of the Municipal Medical Insurance Center. Go to the office of the Municipal Medical Insurance Center to apply for the examination and registration of expenses. For the expenses incurred by the insured person for special examination in outpatient clinic due to illness, the insured person shall go to the Municipal Medical Insurance Center in the following month with the medical record of outpatient clinic under medical insurance, special examination order, medical insurance prescription, medical insurance invoice and so on for the examination and registration formalities. Expenses incurred for special treatment in outpatient clinics due to illnesses of the insured persons shall be examined and registered at the Municipal Health Insurance Center every two months with the medical insurance outpatient medical records, special treatment orders, medical insurance prescriptions, examination orders, medical insurance invoices and so on. Participants who are entitled to chronic disease subsidies, the costs incurred in outpatient treatment, medication, in June and December each year with outpatient medical records, medical insurance prescriptions, medical insurance invoices and other municipal health insurance centers for audit and registration procedures.
(2) When the insured person goes through the expense audit and registration procedures, the office will count whether the audit materials are complete on the spot and issue an acceptance receipt. If the materials are not complete, the participant will be informed of the materials that need to be submitted at once. The insured person shall make up for it within 10 working days.
(3) In accordance with the relevant provisions of the National "Three Catalogs", the Office will complete the cost verification of all accepted materials in the same month and provide a list of non-reimbursable costs and proportionate costs in each accepted material. For medical expenses that need to be investigated and verified, the review time will be extended appropriately, but the maximum time will not exceed 60 working days from the date of acceptance of the materials.
Expense settlement: (1) The 15th to 20th of the month following the month of audit and registration is the time for expense settlement (postponed in case of holidays). During this period, the insured person can go to the office of the Municipal Health Insurance Center to settle the expenses. Special cases will be notified by the Municipal Health Insurance Center by phone in advance.
(2) At the time of settlement, the office will provide a list of the components of the medical expense reimbursement, including the amount of the overall reimbursement, the amount of out-of-pocket expenses, the composition of the classification of out-of-pocket expenses, and the breakdown of out-of-pocket expenses, so as to ensure that the insured person can settle the bill in a clear and transparent manner.
(3) The insured person must hold his/her original ID card to fulfill the signature settlement procedure. I can not go to the Municipal Health Insurance Center for reimbursement of withdrawals, can be entrusted to another person to do it, the delegate should show the original identity card of the person and the delegate, and provide a copy to be retained, for inspection.
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