Chongqing urban and rural medical insurance reimbursement for serious illness

The reimbursement process of serious illness medical insurance: Step 1, the insured persons bring their ID cards, medical insurance cards and medical bills to the medical insurance department of the local designated hospital to fill in the relevant forms for preliminary examination. The second step, the designated hospitals will report the insured residents' information passed the preliminary examination to the urban medical insurance agency for review. The third step is that the insured residents who pass the final examination will be reimbursed by the urban medical insurance agency for serious illness medical insurance. Article 27 of the Social Insurance Law: If an individual who participates in the basic medical insurance for employees reaches the statutory retirement age and the accumulated payment reaches the number of years stipulated by the state, he will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits according to the state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state. Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations. Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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. Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope: (1) should be paid by the industrial injury insurance fund; (2) It shall be borne by a third party; (3) borne by public health; (4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party. Thirty-first social insurance agencies may, according to the needs of management services, sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior. Medical institutions shall provide reasonable and necessary medical services for the insured.

Legal objectivity:

Article 2 of the Measures for the Administration of Serious Illness Insurance for Urban and Rural Residents of Insurance Companies

The term "serious illness insurance" as mentioned in these Measures is the expansion and extension of the basic medical security system, and it is an institutional arrangement to further protect seriously ill patients from high medical expenses.

Article 30

Insurance companies should follow the principle of seeking truth from facts, being objective and fair, standardize audit standards, audit and pay the medical expenses of the insured in strict accordance with relevant local policies, regulations and insurance contracts, promptly notify the insured and relevant government departments of irregularities such as false medical treatment, hanging bed hospitalization and excessive medical treatment, and put forward relevant suggestions.