How to reimburse the employee medical insurance card when you are hospitalized and how to charge

In the current medical reimbursement process, the insured does not have to go through the reimbursement procedures, and the reimbursement will be given at the time of discharge settlement.

If the insured is hospitalized, he or she must give the hospital a deposit in advance, and after ** healing, he or she will be discharged from the hospital and the medical insurance institution directly, and the insured only needs to bear the self-pay part.

For example, if the hospitalization cost is 20,000 yuan, deducting the starting line of 1,000, if it is reimbursed according to 80%, the remaining 19,000 yuan 80% = 15,200 yuan is borne by the social security, and I bear 19,000 * 20% + 1,000 yuan of the starting line = 4,800 yuan.

The insured only needs to hand over 4,800 yuan to the hospital, and the reimbursement of 15,200 yuan will be directly settled by the hospital and the medical insurance.

When you are hospitalized, you will submit your medical insurance card, medical insurance handbook and ID card to the hospital to go through the medical insurance hospitalization procedures, and the hospital will generally charge a certain amount such as a few hundred.

The deposit of thousands of yuan is directly settled when discharged, and the computer of the hospital and the computer of the medical insurance center are linked, and the system will automatically calculate how much the pooler pays (that is, the reimbursement part, which is settled directly by the hospital and the medical insurance), and how much the individual pays. For the personal payment part, according to the deposit previously paid, the excess will be refunded and the deficiency will be compensated, and then the invoice will be printed, and the patient can go home without having to care about how the pooled fund of the medical insurance is given to the hospital. There are also detailed items on the settlement slip printed by the hospital, so you can take a closer look.

Employees who are hospitalized with medical insurance will be paid directly with their medical insurance cards when they are discharged, and they do not need to report the amount of slag after the fact. The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit.

Legal analysis: Reimbursement of hospitalization by employee medical insurance requires employees to seek medical treatment and purchase drugs in designated medical institutions, or to purchase drugs at designated retail pharmacies determined by social security institutions with medical prescriptions issued by doctors in designated hospitals. In addition, if the employee meets the scope and payment standards of the basic medical insurance drug catalogue and diagnosis and treatment items in the process of medical treatment, he or she can use the medical expense list, hospitalization summary and other materials to submit to the local medical insurance bureau for reimbursement.

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

Under normal circumstances, employees should register when they are admitted to the hospital, and they can settle directly in the hospital with their medical insurance cards when they are discharged.

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

Article 29.

The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled 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 celebrate the establishment of a settlement system for medical expenses for medical treatment in other places, so that the insured persons can enjoy basic medical insurance benefits.

1.When hospitalized, patients with medical insurance need to go through social security registration procedures with their ID cards, and then go to the hospital for hospitalization.

2.When discharged, the patient should go to the hospital billing office to go through the settlement procedures with the hospitalization registration form and ID card, and then go to the medical insurance office set up by the hospital for settlement with the hospitalization receipts, billing documents, insurance card and ID card.

[Extended content].

Specific ways to reimburse hospitalization expenses by medical insurance:

1.If you are hospitalized in a social security designated medical institution in the place of insurance, you can directly use the medical insurance for reimbursement and settlement when you pay the premium, but because the medical insurance reimbursement ratio and other regulations are different in different places, the specific amount of reimbursement is subject to local regulations;

2.If you are hospitalized in a different place, you also need to go through the filing of the medical treatment in other places in advance, which can be filed on the "Remote Medical Treatment Filing" applet, or go to the medical insurance service center in the insured place for the record, etc., if you have not filed in advance, but you are hospitalized in a different place due to an emergency illness, you need to call the medical insurance service center in the insured place first** to communicate, and the other party agrees before filing. If the reimbursement and settlement cannot be made in the hospital, the relevant information (such as hospitalization summary, medical expense list, etc.) can be kept, and then go to the medical insurance service center for reimbursement after returning to the insured place.