What is a piecemeal reimbursement? What does sporadic reimbursement mean

Sporadic reimbursement generally refers to the sporadic reimbursement of medical expenses, which refers to the situation that the insured person fails to settle in the hospital due to various reasons and needs to apply for reimbursement of medical expenses at the medical insurance agency where the insurance is insured.

Sporadic reimbursement mainly includes the following situations (taking Xi'an as an example):

1. Emergency admission: expenses that cannot be settled in the hospital due to emergency rescue and other reasons.

2. Resettlement in other places: the medical expenses incurred by the insured persons in returning to their hometowns (the insured employee unit needs to issue a statement on the resettlement situation).

3. Transfer to other places for medical treatment: the medical expenses incurred by the insured employees who have completed the procedures for transferring to other places for medical treatment (due to the medical level of Xi'an City, the insured patients are unable to participate in the disease, and the hospital medical insurance office in Xi'an needs to fill in the referral approval form, and the hospital medical insurance office will review and seal, and after the audit is passed, go to the medical insurance agency where the insurance is insured for approval and filing).

In particular, it refers to the situation that due to objective reasons, you cannot use the card to see a doctor in the hospital and need to apply to the medical insurance bureau for reimbursement of medical expenses. Sporadic reimbursement mainly includes the following situations:

Emergency admission: Hospitalization in a non-designated hospital due to emergency or rescue and cannot be reimbursed by card (hospital emergency certificate must be provided).

Transfer to other places for medical treatment: It is necessary to go through the procedures for referral from other places and be approved.

Relocation procedures: Relocation procedures are required and approved.

Accidental injury and death allowance for minors: Minors who are injured in accidents must provide relevant certification materials from the school or neighborhood office; The following materials are also required for death due to illness or accident: death certificate (hospital death certificate for death due to illness, certificate of school, street, village or town for death due to accident and not admitted to the hospital), cremation certificate, household registration book, legal beneficiary's ID card and photocopy.

For those who participate in the basic medical insurance for urban employees, the medical expenses incurred in 9 situations can be reimbursed sporadically: the medical expenses of inpatient and outpatient specific items (hereinafter referred to as "Gate") and outpatient chronic diseases (hereinafter referred to as "Door") incurred by long-term personnel stationed abroad in medical institutions designated by them in other places; Inpatient medical expenses incurred after going through the relevant formalities and transferring to a designated medical institution in another place; During the period of going out, the hospitalization (including outpatient rescue) medical expenses incurred due to emergency illness after outpatient rescue (or death), and the registration procedures for medical treatment in other places are carried out in accordance with the regulations (the "rescue" referred to in this article shall be implemented in accordance with the "Jiangsu Provincial Diagnostic Standards for Acute and Critical Illness"); If the local emergency is transferred to hospitalization (or death) after the outpatient rescue, the rescue medical expenses incurred in the outpatient clinic (except for those who have enjoyed the treatment of "slow door" and "gate special"); If the employer and the employee make up the arrears and late fees within three months from the month of interruption or insufficient payment, the relevant medical expenses incurred during the period of arrears, hospitalization, "gate", "slow door", and hospitalization (or death) due to emergency treatment after outpatient rescue (excluding flexible employees); If the medical insurance benefits are suspended due to the failure to handle the retirement (job) confirmation and pension qualification certification, etc., and the hospitalization, "gate", "door" and "slow door" during the period of treatment suspension are met, and the relevant medical expenses related to hospitalization (or death) after outpatient rescue due to emergency illness; If the disease is diagnosed within the scope of "Gate" during hospitalization, the minimum payment standard for hospitalization shall be borne by the individual, or if the disease is confirmed to be within the scope of "Gate" through outpatient examination, the outpatient examination and diagnosis fee shall be borne by the individual.

Sporadic reimbursement means: because of the failure to apply for hospitalization filing, resulting in the inability to reimburse, the patient needs to take various bills (lost application for replacement) to the social security bureau for reimbursement procedures.

Eligible medical expenses paid by individuals such as medical treatment in other places, designated medical treatment in other places, and emergency treatment for those who participate in medical insurance.

Legal analysis: sporadic reimbursement generally refers to the sporadic reimbursement of medical expenses, which refers to the situation that the insured person fails to settle the account in the hospital for various reasons and needs to apply for reimbursement of medical expenses through the medical insurance agency where the insurance is insured. Sporadic reimbursement mainly includes the following situations (taking Xi'an as an example):

1. Emergency admission: expenses that cannot be settled in the hospital due to emergency rescue and other reasons 2. Non-local resettlement: medical expenses incurred by the insured person when he returns to his or her hometown (the insured employee unit needs to issue a statement on the resettlement of the insured person) 3. Transferred to other places for medical treatment

The medical expenses incurred by the insured employees who have completed the procedures for transferring to other places for medical treatment (due to the medical level of Xi'an City, the insured patients are unable to fill in the referral approval form in Xi'an Grade 3A and above hospitals, and the hospital medical insurance office will review and seal, and after the review is passed, they will go to the medical insurance agency where the insurance is insured for approval and filing).

Legal basis: Article 30 of the Social Insurance Law of the People's Republic of China The following medical expenses are not included in the scope of payment of basic medical insurance**: (1) shall be paid from work-related injury insurance**; (2) It shall be borne by a third party; (3) It shall be borne by public health; (4) Seeking medical treatment outside the country.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party. Article 31 According to the needs of management services, social insurance agencies may sign service agreements with medical institutions and drug business units to standardize medical services.

Legal analysis: Sporadic reimbursement generally refers to the sporadic reimbursement of medical expenses, which refers to the situation that the insured person needs to apply for reimbursement of medical expenses at the medical insurance agency where the insured person is insured due to the failure to settle the account in the hospital due to various original reasons.

Legal basis: Social Insurance Law of the People's Republic of China

Article 2: The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance ** to pay the positive target.

Legal analysis: Sporadic reimbursement generally refers to the sporadic reimbursement of medical expenses, which refers to the situation that the insured person fails to settle the account in the hospital due to various reasons and needs to apply for reimbursement of medical expenses at the medical insurance agency where the insurance is insured.

Legal basis: "Social Insurance Law of the People's Republic of China" Article 29 The part of the medical expenses of the insured person that should be paid by the basic medical insurance shall be settled directly by the social insurance agency and the medical institution and the drug business unit.

The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in the Yimao Mountain area, so as to facilitate the insured persons to enjoy the basic medical insurance benefits.

Summary. Hello dear, happy to answer your <>

Personal sporadic reimbursement refers to a special circumstance in which the insured person needs to apply for reimbursement to the social insurance agency after paying the medical expenses in advance due to some objective reasons. The sporadic reimbursement of medical expenses in medical insurance is mainly divided into three categories: general hospitalization, specific outpatient clinics and general outpatient clinics.

What does it mean to be reimbursed sporadically by individuals.

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Personal sporadic reimbursement refers to a special circumstance in which the insured person needs to apply for reimbursement to the social insurance agency after paying the medical expenses in advance due to some objective reasons that cannot be directly settled in the hospital. The sporadic reimbursement of medical expenses of medical insurance is mainly divided into three categories: general chain burn inpatient hospitalization, specific BING outpatient clinic and general outpatient clinic.

Personal sporadic reimbursement is a premature disturbance through the social security card service bank allocated to the personal bank settlement account in the social medical insurance voucher of the insured person. If the insured person holds a social security card, he or she should go through the activation procedures of the financial account in a timely manner, and can directly pay the blind Dan to get reimbursement expenses; If the insured person still holds a medical insurance card and has not applied for a social security card, he or she needs to withdraw it at the counter of the bank branch of the medical insurance card service.

It's that it should have been reimbursed in the hospital, but it wasn't reimbursed. Finally, take the invoice, list, and diagnosis certificate, and go to the medical insurance bureau for reimbursement. This is known as sporadic reimbursement.

The basic medical expenses incurred within the scope of the provisions for the reimbursement of sporadic medical expenses shall be paid by the insured person in advance, and the declaration procedures shall be completed with the unit or the retirement management office within one month from the date of discharge from the hospital (or payment of medical expenses); The person in charge of the unit shall carry the relevant information to the designated window of the secondary agency of the municipal medical insurance to go through the procedures for reimbursement of sporadic medical expenses.

For those who participate in the basic medical insurance for urban employees, the medical expenses incurred in 9 situations can be reimbursed sporadically: the medical expenses of inpatient and outpatient specific items (hereinafter referred to as "Gate") and outpatient chronic diseases (hereinafter referred to as "Door") incurred by long-term personnel stationed abroad in medical institutions designated by them in other places; Inpatient medical expenses incurred after going through the relevant formalities and transferring to a designated medical institution in another place; During the period of going out, the hospitalization (including outpatient rescue) medical expenses incurred due to emergency illness after outpatient rescue (or death), and the registration procedures for medical treatment in other places are carried out in accordance with the regulations (the "rescue" referred to in this article shall be implemented in accordance with the "Jiangsu Provincial Diagnostic Standards for Acute and Critical Illness"); If the local emergency is transferred to hospitalization (or death) after the outpatient rescue, the rescue medical expenses incurred in the outpatient clinic (except for those who have enjoyed the treatment of "slow door" and "gate special"); If the employer and the employee make up the arrears and late fees within three months from the month of interruption or insufficient payment, the relevant medical expenses incurred during the period of arrears, hospitalization, "gate", "slow door", and hospitalization (or death) due to emergency treatment after outpatient rescue (excluding flexible employees); If the medical insurance benefits are suspended due to the failure to handle the retirement (job) confirmation and pension qualification certification, etc., and the hospitalization, "gate", "door" and "slow door" during the period of treatment suspension are met, and the relevant medical expenses related to hospitalization (or death) after outpatient rescue due to emergency illness; If the disease is diagnosed within the scope of "Gate" during hospitalization, the minimum payment standard for hospitalization shall be borne by the individual, or if the disease is confirmed to be within the scope of "Gate" through outpatient examination, the outpatient examination and diagnosis fee shall be borne by the individual.

Summary. Hello dear, it is a pleasure to serve you <>

Personal sporadic reimbursement refers to the sporadic reimbursement of medical expenses, which refers to the situation that the insured person fails to settle in the hospital due to various reasons and needs to apply for reimbursement of medical expenses at the medical insurance agency where the insurance is insured.

What does it mean to be reimbursed sporadically by individuals.

Hello dear, it is a pleasure to serve you <>

Personal sporadic reimbursement refers to the sporadic reimbursement of medical expenses, which refers to the situation that the insured person fails to settle the account in the hospital due to various reasons and needs to apply for reimbursement of medical expenses at the medical insurance agency where the insured is located.

Sporadic reimbursement in medical insurance refers to the situation that the insured person needs to go to the medical insurance agency where the insured is located to reimburse the medical expenses due to a series of special reasons that are not settled immediately in the medical institution. The reimbursement will be paid directly to the insured person's personal account through the social security card or other means, and can be collected after the account is received.

Does the disbursement mean that the disbursement is settled? Yes.