How to reimburse social security for accidental injury?

General social insurance reimbursement directly to the reimbursement window to brush social security card reimbursement.

The process is as follows:

1. Prepare claim data. When the insured needs to make a claim for accidental injury, he must prepare all the claim information, such as medical diagnosis certificate, original medical expense receipt and prescription, certificate of accidental injury issued by relevant departments, copy of his ID card or household registration certificate, etc.

2. In case of reimbursement in different places, you need to keep all invoices and documents. And go back to the social security location for reimbursement.

First, the reimbursement process:

(1) The insured shall go to the hospital for treatment in time after the accident. At the same time, you can call 955 19 for insurance reporting. After treatment, you can continue to enjoy accidental injury compensation while going to the social security agency to reimburse the basic medical insurance benefits.

(2) The uninsured should be treated first and call 955 19 to report for insurance; After the treatment, you can go directly to China Life Karamay Branch with relevant materials to make claims.

(3) After the treatment, the injured should go to the social security institution that usually reimburses medical expenses. Social security institutions pay the basic medical care first, and then the insurance company pays the second treatment. Karamay City Social Insurance Administration and Karamay District Social Insurance Administration have achieved one-stop service. Although there is no special window in the service window of other institutions, the staff will also help collect information and inform the next claims procedure.

Second, the materials required for reimbursement:

(1) For outpatient treatment, it is required to provide: diagnosis or outpatient medical records, invoices and copies of medical expenses, payment vouchers or split sheets, medication prescriptions and auxiliary inspection reports; Materials to determine the nature of the accident (such as traffic responsibility identification or mediation for traffic accidents).

(2) If you are hospitalized, you need to provide: discharge certificate, settlement invoice, list and its copy, hospitalization medical record, and materials to determine the nature of the accident (such as traffic responsibility letter or mediation letter).

Third, the reimbursement ratio:

1. Level 1 (100% compensation): permanent total blindness; Missing above the wrist joint of both upper limbs or above the ankle joint of both lower limbs; Loss of wrist joint above one upper limb and ankle joint above one lower limb; One eye is permanently completely blind, and one upper limb wrist joint or above is lost; One eye is completely blind forever, and one lower limb is lost above the ankle joint; Permanent complete loss of limb joint function; Permanent and complete loss of chewing and swallowing function; The function of the central nervous system or the function of the thoracic and abdominal organs is extremely damaged, and it is impossible to engage in any work for life. In order to maintain the necessary activities of daily life, we need the help of others.

2. Grade II (75%): both upper limbs, or both lower limbs, or one upper limb and one lower limb, each with two or more three joints permanently losing function; Ten fingers are missing.

3. Grade III (50%): loss of one upper limb above the wrist joint or permanent and complete loss of all functions of three joints of one upper limb; The ankle joint of the lower extremity is missing or all the functions of the three major joints of the lower extremity are completely lost forever; Permanent complete loss of hearing function in both ears; Permanent and complete loss of finger function; Ten toes are missing.

Grade 4.4 (30%): one eye is completely blind forever; Of the three major joints of an upper limb, two joints have completely and permanently lost their functions; Of the three major joints of a lower limb, two joints have completely and permanently lost their functions; One hand contains thumb and forefinger, and it lacks more than four fingers; A lower limb is permanently shortened by more than 5 cm; Permanent complete loss of language function; Ten toes are permanently and completely disabled.

Grade 5.5 (20%): one of the three joints of one upper limb completely and permanently lost its function; Among the three major joints of lower limbs, the function of one joint is completely and permanently lost; The nose is defective and the olfactory function is still obviously impaired.

Grade 6.6 (15%): one thumb and forefinger are missing, or three or more fingers including thumb or forefinger are missing; Three or more thumbs or forefingers in one hand are permanently and completely incapacitated; One foot and five toes are permanently and completely disabled.

Grade 7.7 (10%): one thumb or forefinger is missing, or two or more fingers are missing from middle finger, ring finger and little finger; The thumb and forefinger are permanently and completely disabled.

Legal basis:

People's Republic of China (PRC) Social Insurance Law, Regulations on the Supervision and Administration of the Use of Medical Insurance Funds, and Opinions of the Ministry of Finance of the National Medical Insurance Bureau on Establishing the Medical Insurance Benefits List System, etc. If the insured objects (residents and employees) are hospitalized due to accidental injuries not attributable to the other party, they shall enjoy normal basic medical insurance benefits according to relevant regulations, and the following circumstances shall not be included in the payment scope of the medical insurance fund: they shall be paid by the industrial injury insurance fund and borne by a third party.