Emergency medical insurance can be reimbursed, how to reimbursement

The following cases of emergency can be reimbursed:

1, the participant of a sudden illness is not due to trauma to the emergency room are eligible for reimbursement of medical insurance.

2, the participant belongs to the trauma caused by the disease to the emergency room, the hospital health insurance department and the attending physician will need to review the cause of the injury to determine whether the trauma approval form can be issued, such as the trauma approval form is not approved by the audit is beyond the scope of the reimbursement of the health insurance, the emergency treatment related costs, health insurance will not be reimbursed.

3. If a participant suffers from a critical, emergency or serious illness and is transferred to the hospital after emergency treatment, the emergency medical expenses that meet the requirements can be incorporated into the hospitalization expenses for reimbursement.

I, how to reimbursement

1, health insurance card direct reimbursement: If I can carry a medical card when I go to the doctor, use the card for registration and consultation, etc., can be directly bound with the health insurance system, the hospital in the accounting of the payment of fees, can be real-time settlement of the health insurance, we only need to pay the corresponding costs after deduction.

2, offline reimbursement: If you do not carry a social security card when you visit the clinic, then you can only be reimbursed offline after the clinic, the general offline insurance, the user carries a good hospital payment invoice, medical checklist, medical records, medical certificates and other materials, go to the local social security centers, fill out the information and submit according to the requirements, to be audited and approved, the reimbursement amount will be automatically issued to the medical insurance bonded to the bank account of the card. The first is to make sure that you have a good understanding of the situation.

The reimbursement process

1. To apply for reimbursement of outpatient and emergency medical expenses, the insured person should bring along valid documents (ID card, household register, etc.), Social Security Card or Medical Insurance Card, special receipt for outpatient medical expenses, special receipt for emergency medical expenses, relevant medical history and copies, emergency page and copy of Outpatient and Emergency Record Book (for those who have medical relationship with the city and who have incurred medical expenses at designated medical institutions in the city). (medical expenses incurred at the designated medical institutions of the city for those whose medical relationship is with the city). In case of damage to the Medical Insurance Card, a "Notice of Damage to the Medical Insurance Card" is also required.

2. When applying for reimbursement of hospitalization and emergency room observation expenses, the insured person shall provide a special receipt for medical expenses, a list of medical expenses incurred during hospitalization (a list of medical expenses incurred in the emergency room) and a copy of it, and a copy of the hospital discharge summary.

3. When applying for outpatient medical fee reimbursement for major illnesses, the insured person shall provide a special receipt for outpatient medical fees, a certificate of diagnosis of the disease and a copy of the certificate, and a report of the relevant examination and a copy of the report.

4. Participants can entrust others to handle the application on their behalf. The delegate is required to bring along his/her own and the participant's valid documents (ID card, household register, etc.).

Three, emergency medical insurance reimbursement scope:

Emergency observation room hospital observation which has the following conditions acute severe trauma, traumatic brain injury, fractures, dislocations, lacerations, burns, sudden acute abdominal pain, sudden high fever, sudden hemorrhage, vomiting blood, internal bleeding symbols, diarrhea, severe dehydration, shock, symptoms or coma of the stroke coma in the ear, nose, pharynx, eyes, trachea, bronchus and esophagus with a foreign body in the eyes. and esophagus in the foreign body in the eyes of acute pain, redness and swelling or acute visual impairment respiratory distress, the onset of sudden, severe symptoms, rapid deterioration after the onset of poisoning, drowning, electrocution, acute urinary incontinence, acute allergic diseases, virulent infectious diseases suspected of, as well as other attending physician or above that life-threatening emergency should be resuscitated.

Four, emergency medical insurance reimbursement procedures?

Participants can fill out the "Emergency Reimbursement Application Form" with the diagnosis and treatment manual, emergency invoice, emergency medical record, and discharge certificate (or a copy of the death certificate) at the medical insurance section of the designated hospital where the emergency occurred.

Tips: The medical expenses incurred by the participant who died in emergency treatment, the medical expenses incurred during the period of transferring from emergency treatment to hospitalization, and the medical expenses incurred by the participant in emergency treatment of approved diseases for outpatient prescribed diseases are not included in the scope of payment of the general outpatient co-ordination.

V. Medical insurance reimbursement rate:

1. Outpatient and emergency medical expenses: in the year of the active employees (January 1 to December 31) in line with the provisions of the basic medical insurance coverage of the accumulated medical expenses exceeding 2,000 yuan or more part.

2. Settlement ratio: 50% reimbursement for the part of over 2000 yuan for dispatched staff during the contract period, and 50% out-of-pocket payment by individuals; the maximum amount of outpatient and emergency reimbursement paid to dispatched staff is 20,000 yuan cumulatively in a year.

3. Participants should keep the outpatient medical bills (including receipts and prescription bottoms for the parts below the large amount) of the outpatient treatment at the designated hospitals as the vouchers for reimbursement of medical expenses.

Legal basis

The Social Insurance Law of the People's Republic of China

Article 28: Medical expenses that are in accordance with the drug list, diagnostic and therapeutic items, and standards of medical service facilities of the basic medical insurance, as well as those for emergency treatment and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.