How does Medicare work in Social Security?

Medical insurance in social security provides important medical protection for the insured. When using medical insurance, you need to understand local policies and regulations, choose designated medical institutions for medical treatment, and follow the prescribed procedures for medical treatment, settlement and reimbursement.

I. Understanding medical insurance policy

Before using medical insurance, you first need to understand the local medical insurance policy, including insurance coverage, reimbursement rate, and the process of medical treatment. This information is usually available through social security departments, hospitals or relevant government websites.

Selecting a designated medical institution

Medicare insurance usually requires participants to seek treatment at a designated medical institution, so you need to understand and select a designated medical institution that complies with the regulations before you use your medical insurance. Generally speaking, large public hospitals and community medical institutions are common designated medical institutions.

Third, the medical process

1. Registration: When registering at a designated medical institution, you need to show your social security card or related documents to prove your insurance status.

2. Consultation: According to the condition, choose the appropriate department and doctor for consultation. The doctor will issue a prescription or recommend appropriate tests according to the condition.

3. Payment and settlement: During the medical consultation, the insured person needs to pay part of the fees according to the hospital's requirements, such as registration fee and examination fee. The medical insurance part of the fee will be settled by the hospital and the social security department at the end of the medical treatment.

Fourth, the reimbursement process

For medical expenses that meet the requirements, participants can be reimbursed through the medical insurance. The specific reimbursement process may vary from region to region, but generally includes the following steps:

1. Collecting invoices and vouchers: During the process of medical treatment, pay attention to collecting all invoices and vouchers related to medical expenses, such as outpatient invoices, hospitalization invoices, prescription slips, etc.

2. Submit reimbursement application: Submit the collected invoices and vouchers to the social security department or the designated reimbursement window, fill in the reimbursement application form and attach relevant documents.

3. Audit and payment: The social security department will audit the submitted reimbursement application and, after passing the audit, will pay the reimbursement to the participant's designated account.

In summary:

Medical insurance in social security provides important medical protection for the insured. When using medical insurance, you need to know the local policies and regulations, choose designated medical institutions for medical treatment, and follow the prescribed procedures for medical treatment, settlement and reimbursement. Through the rational use of medical insurance, it can reduce the financial burden of the insured person in case of illness or injury.

Legal basis:

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

Article 28 stipulates that:

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, and medical service facility standards, as well as those for emergencies and resuscitations, shall be paid out of the basic medical insurance fund in accordance with state regulations.

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

Article 29 stipulates:

The portion of a participant's medical expenses that should be paid out of the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institutions and drug business units.

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

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

Article 30 stipulates:

The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid out of the workers' compensation insurance fund;

(2) those that should be borne by a third person;

(3) those that should be borne by the public ****health burden;

(iv) medical treatment outside the country.

Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or if the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.