Employee Medical Reimbursement Process 5, Employee Medical Reimbursement Process

How to reimburse for employee medical insurance?

Reimbursement process for hospitalization of urban residents' medical insurance.

At present, it is also possible to directly handle the settlement directly at the medical insurance office established in the hospital.

The process is: when admitting to the hospital: the insured person shall pay the hospitalization deposit for hospitalization with his ID card and the doctor's admission arrangement.

At the time of discharge: The doctor arranges for discharge, and goes to the hospital's inpatient billing office to settle the discharge fee. Then the hospitalization documents, charging documents, insured medical insurance cards and ID cards are set up in the medical insurance office of the hospital for on-site settlement, and the reimbursement conditions must meet the reimbursement conditions of the resident medical insurance, and the reimbursement ratio is based on the reimbursement level of the hospital, and the hospital has set up a starting point for reimbursement.

The specific policy varies according to local conditions.

Hospitalization reimbursement process for urban employees' medical insurance:

At present, the reimbursement process has been simplified, and patients do not need to go to the social security center for reimbursement, and can directly settle on the spot at the hospital.

The process is as follows: When admitted: patients with medical insurance can go through the social security registration procedures with their ID cards, and then go to the ward for hospitalization.

At the time of discharge: The doctor arranges for the patient to be discharged from the hospital, and goes to the hospitalization fee office to go through the discharge settlement procedures with the admission registration form and ID card.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

1. Insured persons must show their citizen card and swipe the card for outpatient and inpatient treatment, and the outpatient clinic must inform the hospital of the type of treatment (such as outpatient chronic diseases, gates), and if the card card is not presented or the type of treatment is not clear, the medical expenses incurred by the insured employees when they seek medical treatment will not be paid by the medical insurance.

2. Insured persons who purchase drugs in designated retail pharmacies must show their citizen cards, inform them of the type of treatment (such as outpatient chronic diseases, gates), and purchase drugs according to the relevant policies.

3. The outpatient department shall coordinate the implementation of the first diagnosis and referral system based on community health service institutions. Insured persons can make the first diagnosis in designated community health service institutions of basic medical insurance for urban employees or medical institutions managed by referring to the community; Specialized hospitals can be used as the first medical institution for all insured persons. If the insured person needs to be referred, the first medical institution shall be responsible for the referral, and emergency and rescue are not subject to this restriction.

After the outpatient chronic disease subsidy limit is used up, the outpatient co-ordination treatment will be directly enjoyed from the next expense, and chronic diseases will not need to be referred for chronic diseases in the original outpatient chronic fixed-point medical treatment. After the subsidy limit for specific outpatient items is used up, you must go through the referral procedures and use the general medical records in accordance with the regulations of outpatient co-ordination in order to enjoy the treatment of outpatient co-ordination. Purchasing drugs at pharmacies is not eligible for outpatient co-ordination treatment.

The reimbursement process for medical insurance is as follows:

Local medical insurance reimbursement: After receiving medical insurance reimbursement in a medical insurance designated medical institution, the medical insurance card can be directly used to settle the reimbursement at the medical machine-based deficit settlement window.

Non-local medical insurance reimbursement: If the insured is difficult to diagnose in the city's medical institutions or has no means, he can apply for transfer to a different place for inpatient diagnosis and treatment, fill in the application form for transfer to a different place, and report to the municipal medical insurance agency for review and filing before transferring to a different place**; If the insured needs to be hospitalized for a sudden emergency illness in a different place, he can file with the Municipal Medical Insurance Center in a timely manner (generally within three days) after admission, and the transfer and emergency medical expenses in other places also need to be paid by the insured first, and then go to the Municipal Medical Insurance Center to go through the reimbursement procedures after discharge, and Yan Fenghu recommends that the reimbursement procedures be handled within one month.

Legal basis: Detailed Rules for the Implementation of the Social Insurance Law of the People's Republic of China

Eighth insured persons in the agreement of the medical expenses incurred in the medical institutions, in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, in accordance with the provisions of the State from the basic medical insurance **.

If the insured person really needs emergency treatment or rescue, he or she can seek medical treatment in a non-agreed medical institution; The scope of drugs that must be used for rescue purposes may be appropriately relaxed. Measures for the management of medical services for emergency and rescue of insured persons shall be formulated by the overall planning area according to the actual local situation.

When <> reimburse medical expenses, you can apply for medical insurance at the hospital or pharmacy where you purchased the medicine with your personal ID card and medical insurance card. Medical insurance reimbursement can also be made directly with a social security card in some areas. When you are discharged from the hospital, you can apply for reimbursement at the hospital with the certificate of the attending doctor, hospitalization materials, personal ID card and medical insurance card.

Social health insurance reimbursement is reimbursed after discharge or transfer.

Settlement procedures for inpatient and special disease outpatient**:

Before the 10th of each month, the designated medical institutions shall report the cost statement, hospitalization statement and relevant information of the discharged patients in the previous month to the medical insurance agency, and the medical insurance agency shall review and use it as the basis for monthly pre-allocation and year-end accounts;

The medical insurance agency pre-allocates the overall expenses of the previous month's inpatient and special disease outpatient clinics** every month;

Insured persons who have been identified as suffering from special diseases shall go to a designated medical institution designated by the labor and social security department to seek medical treatment and purchase medicines, and the medical expenses incurred shall be directly billed and settled immediately.

Emergency settlement procedures: insured personnel due to emergency rescue to the city's non-designated medical institutions and non-local medical institutions hospitalized**, the medical expenses incurred, first paid by the individual or unit, after the end of the emergency rescue, with the hospital emergency medical records, examinations, laboratory reports, invoices, detailed medical charges to the medical insurance agency according to the provisions of the reimbursement procedures.

Where can I apply for a social security card?

1. The employees and retirees of the employer shall be paid by the unit to which they belong;

2. The insured personnel who are filed in the employment agency and talent center shall collect them at the employment agency and talent center;

3. Students in school and kindergarten insured persons in schools and kindergartens to collect;

4. Retirees, urban and rural elderly, residents of working age, and non-school students and children who enjoy flexible employment and socialized management in urban areas can receive them at the street social security office.

5. The electronic social security card can be applied for through multiple channels such as the APP of the human resources and social security department, the government service APP, the APP of the cooperative issuing bank, and the standardized social and livelihood service APP.

[Legal basis].

Article 28 of the Social Insurance Law of the People's Republic of China conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with national regulations from the basic medical insurance **.

Summary. 1. When purchasing drugs, the cardholder goes to the designated institution of medical insurance to buy drugs, and the cost goes to the personal account; Medical insurance is divided into two accounts, personal account, the money embodied in the medical insurance card, can be used to buy drugs in designated pharmacies, the payment of outpatient expenses and the payment of the self-paid part of hospitalization expenses; The pooled account is managed by the medical insurance center, and the expenses incurred by the insured persons in line with the local medical insurance reimbursement are paid by the pooled account. 2. Go to the outpatient clinic to see a doctor, keep the original diagnosis certificate, medical records, reports, charging documents, etc., and go to the local social security agency for reimbursement; At the time of checkout, the part paid by the individual shall be paid by himself with the medical insurance card or cash, and the part reimbursed by the medical insurance shall be settled by the medical insurance and the hospital, and the individual does not need to pay first and then reimburse; 3. When hospitalized, deposit a certain deposit first, and settle the payment according to the reimbursement ratio of medical insurance when discharged.

When reimbursing hospitalization, there is a starting line, that is to say, the money from the starting line needs to be paid by yourself, and the part that exceeds the minimum payment line can be reimbursed according to the provisions of local medical insurance, and the reimbursement ratio is different from place to place, about 75%.

1. When purchasing drugs, the cardholder goes to the designated institution of medical insurance to buy drugs, and the cost goes to the personal account; The medical insurance is divided into two accounts, the account of the Chinese Macro person, the money reflected in the medical insurance card, can be used to buy drugs in designated pharmacies, the payment of outpatient expenses and the payment of the self-paid part of hospitalization expenses; The overall account is managed by the medical insurance center, and the expenses incurred by the insured person in accordance with the local medical insurance reimbursement are paid by the unified account. 2. Go to the outpatient clinic to see a doctor, keep the original diagnosis certificates, medical records, reports, charging documents, etc., and go to the local social security agency for reimbursement; At the time of checkout, the part paid by the individual shall be paid by himself with the medical insurance card or cash, and the part reimbursed by the medical insurance shall be settled by the medical insurance and the hospital, and the individual does not need to pay first and then reimburse; 3. When hospitalized, deposit a certain deposit first, and settle the payment according to the reimbursement ratio of medical insurance when discharged. When reimbursing hospitalization, there is a starting line, that is to say, the money from the starting line needs to be paid by yourself, and the part that exceeds the minimum payment line can be reimbursed according to the provisions of local medical insurance, and the reimbursement ratio is different from place to place, about 75%.

The basic medical insurance for urban employees is a social insurance system established to compensate workers for economic losses due to the risk of disease and chain digging, and it is also one of the components of China's medical insurance. Through the employer and individual payment, the establishment of medical insurance**, after the insured person is sick and incurs medical expenses, and the medical insurance agency will give a certain amount of economic compensation, so as to avoid or reduce the economic risk borne by the worker due to illness, **, etc.

Legal analysis: First go to the public hospital designated by the medical insurance for hospitalization** within three working days of hospitalization, you must go to the hospital medical insurance office to register and file the hospitalization application form, hospitalization invoice, detailed list, and medical records when you are discharged. If it is a traumatic injury, you should also go to the medical insurance office of the hospital to fill in the trauma form and stamp the official seal of the hospital where you live and the official seal of the insured unit, write a description of each person, and go to the office on the second floor of the Social Labor and Social Security Bureau for reimbursement with a description or certificate of the insured unit.

Information required for employee medical insurance reimbursement: hospitalization reimbursement: invoice (original), discharge certificate (original), detailed list of hospitalization expenses, basic medical insurance for urban employees, hospitalization registration to indicate that the land farmer to non-insured personnel and individual insured persons are also required, a copy of the ID card, and special outpatient reimbursement:

Outpatient invoice (original), outpatient prescription (original), special outpatient approval form.

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

Article 23 Employees shall participate in the basic medical insurance for employees, and the employer and the employees shall jointly pay the basic medical insurance premiums in accordance with the provisions of the State. Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

Article 24: The State is to establish and improve a new type of rural cooperative medical system. The management measures for the new type of rural cooperative medical care shall be stipulated by ***.