How to reimburse the medical expenses of social security and medical insurance

How to reimburse the medical expenses of social security and medical insurance

There are two main reimbursement methods for medical expenses of social security and medical insurance: one is outpatient reimbursement, and the other is hospitalization reimbursement.

Outpatient reimbursement needs to be registered in a designated medical institution first, and then go to the outpatient clinic with a medical insurance card or social security card, and pay a certain percentage of the expenses. Medical expenses above the Qifubiaozhun and below the maximum payment limit of the medical insurance pooling fund can be reimbursed by the medical insurance pooling fund in proportion. The specific reimbursement ratio and qifubiaozhun need to be determined according to the local medical insurance policy.

Hospitalization reimbursement needs to go through hospitalization procedures first, and then register with medical insurance card or social security card. Medical expenses above the Qifubiaozhun and below the maximum payment limit of the medical insurance pooling fund can be reimbursed by the medical insurance pooling fund in proportion. The specific reimbursement ratio and qifubiaozhun need to be determined according to the local medical insurance policy.

It should be noted that the reimbursement scope and proportion of social security medical insurance are influenced by many factors, such as the type of medical insurance, the place of insurance, the level of medical institutions, and the drug list. Therefore, before reimbursing medical expenses, it is recommended to know the local medical insurance policies and regulations.

To sum up:

There are two main ways to reimburse medical expenses for social security and medical insurance: outpatient reimbursement and hospitalization reimbursement. The specific reimbursement ratio and qifubiaozhun need to be determined according to the local medical insurance policy. Before reimbursement, it is recommended to know the local medical insurance policies and regulations.

Legal basis:

Article 28 of the Social Insurance Law of People's Republic of China (PRC) stipulates that 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 of the Social Insurance Law of People's Republic of China (PRC) stipulates that the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

Article 30 of the Social Insurance Law of People's Republic of China (PRC) stipulates that the state shall establish and improve the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.