Reimbursement process of general outpatient service in Weihai

I. Information required for reimbursement

1. Outpatient reimbursement information: outpatient invoice, cooperative medical certificate calendar (or medical record).

2. Hospitalization reimbursement materials: hospitalization invoice, cooperative medical certificate (or medical record) calendar, detailed list of expenses, discharge summary and other relevant certificates.

3, outpatient special disease reimbursement information: outpatient invoices, special disease cooperative medical certificate calendar.

4. Information for handling special diseases: outpatient treatment proposal for special diseases, calendar of cooperative medical certificate, medical records, relevant laboratory reports and photos.

Second, the reimbursement process:

Insured households submit the required materials for reimbursement to the village (community) cooperative medical liaison, and report to the town cooperative medical liaison after the audit of the village (community) cooperative medical liaison, and the town cooperative medical liaison will send it to the district agricultural office for reimbursement.

Guide to reimbursement of new rural cooperative medical care;

Direct reimbursement for hospitalization: When going through the hospitalization formalities due to illness, you will go to the hospital to directly participate in reimbursement with the certificate of the new rural cooperative medical system.

Reimbursement by the town's new rural cooperative medical office: the reimbursement materials are brought to the new rural cooperative medical office by individuals, reported by the town's agricultural medical office to the county's agricultural medical office for reimbursement, and then the town's agricultural medical office calls to collect reimbursement fees.

Required materials: discharge certificate, official invoice, expense list, household registration book, ID card and rural cooperative medical certificate. Hospitalization in different places requires preparation: hospitalization summary, first hospitalization course record and discharge record. Hospitalization outside the district requires preparation: admission records and discharge records.

Trauma hospitalization, but also need to prepare: trauma certificate, admission records. (Trauma certificate-detailed certificate issued by the local village community and stamped with the official seal of the village committee) Maternity hospitalization: local normal delivery hospitalization needs: birth certificate, birth certificate.

Normal delivery needs in other places: birth certificate, birth permit, admission record and discharge record.

Materials required for caesarean section (local or foreign): birth certificate, birth certificate, admission record and discharge record.

Handling of special outpatient service: For patients with diabetes, hypertension (stage II and above), malignant tumor (radiotherapy and chemotherapy), psychosis, leukemia, liver cirrhosis, uremia (outpatient dialysis), systemic lupus erythematosus, chronic rheumatic heart disease, cerebrovascular accident and other special diseases who have never been hospitalized within one year, the accumulated outpatient expenses will be compensated in proportion at the end of the year (note: after the diagnosis is made by the designated medical institutions in the county, the application form will be filled in the hospital.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 1 This Law is formulated in accordance with the Constitution for the purpose of adjusting the social insurance relationship, safeguarding citizens' legitimate rights and interests in participating in social insurance and enjoying social insurance benefits, enabling citizens to share the fruits of development and promoting social harmony and stability.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Article 3 The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.