Local online settlement was officially launched on June 5438+ 10/in 2022. Insured persons who are hospitalized in Yantai can enjoy one-stop settlement directly at the hospital window, and there is no need for individuals to advance the reimbursement amount of Huimin insurance.
Second, the reimbursement process for hospitalization in different places
After the insured person hospitalized in different places is discharged from the hospital, the individual advances the reimbursement amount of public medical insurance in advance. The citizen health insurance system automatically accumulates deductibles. For the insured who exceeds the deductible and should be reimbursed, the customer service will contact the insured to submit the materials at the designated window, waiting for the reimbursement.
Materials to be submitted: claim application, hospitalization medical records, details of medical treatment, original invoices, original settlement forms (stamped by hospitals or medical insurance), copies of the front and back of ID cards, and copies of bank cards (four major banks of China Agriculture, Industry and Construction).
Note: If minors or uninsured persons apply in person, copies of ID cards of guardians and agents, proof of guardianship relationship and power of attorney are also required.
settle a claim
(A) the local designated medical institutions "one-stop" settlement
(2) claim settlement after medical treatment in different places
(3) Claims for certain high-value drugs
(4) Drugs claiming to have special curative effects.
Legal basis:
Yantai citizen health insurance
settle a claim
(A) the local designated medical institutions "one-stop" settlement
The "Yantai citizen medical insurance" settlement platform is directly connected with Yantai medical insurance settlement system. From 0: 00 on June 65438+1 October1day to 24: 00 on February 3 1 day in 2023, the medical expenses that meet the claim conditions in the designated medical institutions of Yantai basic medical insurance can be settled simultaneously with basic medical insurance and serious illness insurance at the hospital.
(2) claim settlement after medical treatment in different places
The insured can report and settle claims through the official WeChat account of Yantai Citizen Health Insurance or the customer service telephone number 400- 182-6688, upload relevant claims materials through the official WeChat account or mail them to the designated address, or submit the materials at the designated claims window in each district and city. When the claim amount is more than 5000 yuan, the original should be provided as required by the insurance company.
Yantai citizen medical insurance system automatically accumulates deductible line. For the insured who exceeds the deductible line and should be reimbursed, the customer service will contact the insured to submit supplementary materials such as bank cards for review and reimbursement. The insured can also call the customer at 400- 182-6688 for consultation.
(3) Claims for certain high-value drugs
Claims for some high-value drugs can be divided into two situations: local medical treatment in Yantai and medical treatment in different places. According to the actual situation of drug purchase, the insured can choose two ways to apply for claims for some high-value drugs: direct payment and afterwards claims.
Direct payment for drug purchase: When the insured needs to purchase drugs but has not yet purchased them, he can first submit an application for direct payment for drug purchase and claim settlement in the official account of "Yantai Citizen Medical Insurance" WeChat. After the rationality of drug use is recognized, the insured can purchase drugs from some designated pharmacies with high prices. When purchasing drugs, the insured only needs to pay part of the expenses borne by the individual to complete the drug purchase and claim settlement, which is referred to as "special drug direct compensation service".
After-the-fact claim: The insured can submit an application for after-the-fact claim in the official account of "Yantai Citizen Medical Insurance" WeChat, and after purchasing drugs at the designated pharmacies or hospitals with higher prices in advance. After the rationality of drug use is approved, the claims will be remitted to the bank account provided by the insured.
(4) Drugs claiming to have special curative effects.
Refer to the claim process of specific high-value drugs in Responsibility III. The insured can apply for drug protection with special effects on the platform designated by Yantai citizens' medical insurance with drug prescriptions, medical records and other claims materials. Need to coordinate the use of drugs in different places, by the special efficacy drug suppliers to provide services to ensure the use of special efficacy drugs.