Hefei Medical Insurance Reimbursement Process

Hefei medical insurance reimbursement process;

1, emergency treatment, rescue and observation in different places, shall notify the municipal medical insurance agency within three days (except holidays) from admission, otherwise the medical expenses pooling fund will not pay.

Medical expenses incurred due to emergency treatment, rescue, observation and hospitalization shall be paid in advance by the patient or his unit, and settled by the patient or his close relatives to the municipal medical insurance agency within 30 days after the end of medical treatment; The expenses in the basic medical insurance coverage of urban workers in this Municipality shall be paid by individuals first, and the rest shall be settled according to the hospitalization standard of tertiary hospitals in this Municipality;

2, the insured disease in the city within the scope of the highest level designated medical institutions (including specialist) is difficult to diagnose or diagnosis has been clear but there is no effective treatment, with the consent of the municipal medical insurance agencies, can be transferred to different medical insurance designated medical institutions for hospitalization.

The medical expenses incurred in transferring to a different hospital shall be paid in advance by the patient or the unit to which he belongs, and settled by the patient or his close relatives to the municipal medical insurance agency within 30 days after the end of medical treatment; The expenses in the basic medical insurance coverage of this Municipality shall be paid by individuals first, and the rest shall be settled according to the hospitalization standard of tertiary hospitals in this Municipality.

Hefei residents' medical insurance transfer reimbursement materials:

1, resident medical insurance card or patient ID card and household registration book;

2. The filed Application Form for the Transfer of Basic Medical Insurance for Urban Residents in Hefei;

3. Invoice for hospitalization expenses;

4, discharge records or discharge summary;

5. Detailed total cost list;

6. If the hospitalization operation involves medical materials of more than 1 1,000 yuan, the barcode certificate of the origin of the medical materials shall be provided;

7, other special circumstances need to review the materials.

To sum up, the medical insurance reimbursement process for medical treatment in different places is to apply for medical treatment in different places at the medical insurance center of the insured place, and then put it on record at the medical insurance center of the insured place, and wait until the medical insurance center of the insured place submits the reimbursement with the settlement bill and daily bill.

Legal basis:

"Detailed Rules for the Implementation of People's Republic of China (PRC) Social Insurance Law" Article 8.

The medical expenses incurred by the insured in the agreed medical institutions that meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards shall be paid from the basic medical insurance fund in accordance with state regulations. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.