Can you still get reimbursed for hospitalization with your health insurance card?

A. The relationship between health insurance card funds and reimbursement

The funds in the health insurance card mainly come from the individual's health insurance contributions, and these funds are stored in the individual's account and used to pay for the individual's medical expenses. However, the funds in the card are not unlimited, and once they are used up, the individual will need to pay out of pocket or through other means.

If an individual uses his or her health insurance card to pay for medical expenses during a hospitalization, that portion of the cost is actually deducted from the individual's account. Reimbursement, on the other hand, means that after the individual pays for the medical expenses, according to the medical insurance policy, the medical insurance fund compensates for the part of the expenses paid by the individual. Therefore, the use of funds in the medical insurance card and reimbursement are two different concepts.

The reimbursement process for hospitalization expenses

When an individual incurs expenses during hospitalization, he or she first needs to use the medical insurance card to make payments. When discharged from the hospital, the hospital will provide a list of relevant expenses and invoices. Individuals can submit these expense lists and invoices to the health insurance department for reimbursement according to the provisions of the health insurance policy.

The health insurance department will review the expenses submitted by the individual based on the individual's health insurance contribution status, the details of the hospitalization expenses, and the provisions of the health insurance policy. If the conditions for reimbursement are met, the health insurance department will reimburse the expenses paid by the individual according to a certain percentage.

It is important to note that the reimbursement rates, scope and conditions may vary from one health insurance policy to another. Therefore, it is best for individuals to understand their local health insurance policies before hospitalization so that they can use their health insurance cards appropriately and be reimbursed correctly during the hospitalization period.

Three: What to do if the card is insufficient

If the card is insufficient to cover the full cost of the hospitalization, then the individual will have to pay the rest of the cost out-of-pocket. At this point, the individual can still submit the portion of the cost that has already been paid with the card to the health insurance department for reimbursement. The health insurance department will reimburse eligible expenses according to the policy.

In summary:

Money spent on hospitalization with the medical insurance card is mainly used to pay for the individual's medical expenses, while the reimbursement is based on the individual's medical insurance contributions and the medical insurance policy regulations, and the medical insurance fund will compensate for the part of the expenses paid by the individual. During hospitalization, individuals should use their medical insurance cards wisely and know the local medical insurance policy in order to make reimbursement correctly. When the medical insurance card has insufficient funds, the individual needs to pay the remaining part out of pocket, but can still submit the paid expenses to the medical insurance department for reimbursement.

Legal basis:

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

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 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 from 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.