How to reimburse Shanghai hospitalization expenses medical insurance

People who are hospitalized need to collect the necessary documents, submit a reimbursement application in accordance with the stipulated process, and comply with the relevant provisions of the health insurance policy.

I. Hospitalization Expenses and Settlement

In Shanghai, people will incur a series of expenses during their hospitalization, including bed charges, nursing fees, surgical fees, and medicine fees. These costs are usually settled by the hospital when the patient is discharged and a list of costs and invoices are issued.

II. Reimbursement Rates and Scope of Medical Insurance

Shanghai's medical insurance policy stipulates the reimbursement rates and scope of different medical expenses. Generally speaking, the costs of medicines, diagnostic and therapeutic items and service facilities that are in line with the medical insurance catalog can be included in the scope of reimbursement under the medical insurance. Specific reimbursement rates vary depending on the type of health insurance the patient has (e.g., employee health insurance, resident health insurance, etc.) and the level of the hospital (e.g., Level 1, Level 2, Level 3 hospitals).

Third, the reimbursement process

1, collect the necessary materials: the patient needs to collect the list of expenses during the hospitalization, invoices, medical insurance card and other related materials.

2. Submit a reimbursement application: Patients or their family members can bring the above materials to the nearest health insurance service window or designated health insurance processing organization to submit a reimbursement application.

3. Audit and settlement: The medical insurance organization will audit the submitted materials to confirm the compliance and authenticity of the expenses. After passing the audit, the health insurance organization will settle the expenses according to the stipulated percentage and pay the reimbursable amount to the patient or his/her family.

4. Notes

1. Ensure the authenticity and completeness of all expense lists and invoices to avoid omissions or misstatements.

2. Know your type of medical insurance and reimbursement rate so that you can accurately account for the amount to be reimbursed during the reimbursement process.

3. Comply with the relevant provisions of the health insurance policy and do not try to obtain undue benefits through illegal means.

In summary:

The process of reimbursement of hospitalization expenses in Shanghai involves the generation of expenses, settlement, reimbursement rate and scope, as well as the specific reimbursement process. Citizens are required to collect the necessary documents during hospitalization, submit reimbursement applications in accordance with the prescribed process, and comply with the relevant provisions of the health insurance policy. Through this process, citizens can enjoy the corresponding health insurance treatment and reduce the financial burden.

Legal basis:

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

Article 28 stipulates that:

Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Shanghai Municipal Employees' Basic Medical Insurance Measures

Article 14 stipulates:

Employees should hold their own medical insurance vouchers to seek medical treatment, and medical expenses incurred in accordance with the provisions of the basic medical insurance shall be paid by the basic medical insurance fund.