Shanghai medical insurance reimbursement process for medical treatment in different places

Shanghai medical insurance off-site reimbursement process;

1, medical expenses of medical insurance personal account are reimbursed by medical insurance in different places. You can go to the medical insurance bureau regularly to handle the fund transfer procedures and transfer the medical insurance fund in the social security card account to your own bank account. Under normal circumstances, outpatient medical expenses are paid by individuals;

2. If you are hospitalized, the reimbursement of medical insurance in different places needs to be reported to the Medical Insurance Bureau for the record. When I leave the hospital, I will go to the medical insurance bureau to settle the hospitalization expenses with the hospital's diagnosis certificate, discharge summary, medication list, medical expense receipt and medical guarantee. If I can't come, I can also entrust an agent to handle it.

3. Provincial hospitals should be designated hospitals for local medical insurance;

4. The reimbursement rate is 88% for the threshold fee of more than 3,000 yuan, 90% for 3,000-5,000 yuan, 92% for 5,000-10000 yuan, and 95% for the maximum payment limit of more than10000 yuan, including 80% for Class B drugs and 70% for precious drugs, and special inspection. Medical expenses of individual medical insurance accounts can be transferred to the medical insurance bureau regularly, and hospitals in other provinces should be designated hospitals for local medical insurance.

Materials required for reimbursement of medical insurance in different places:

1, IC card, basic medical insurance card (green photo) or basic medical handbook for urban residents;

2. A valid receipt document (invoice);

3, hospitalization expenses summary list, medical insurance referral letter of introduction, discharge certificate;

4. Hospitalization materials: the first page of hospitalization medical records, admission records, operation records, discharge summary, large-scale inspection reports, long-term doctor's orders, and copies of temporary doctor's orders (sealed by medical institutions).

To sum up, the insured who participate in and enjoy the basic medical insurance benefits can seek medical treatment in different places. If you go to other places for medical treatment, you need to file it first, and you can settle it by brushing medical insurance at the designated medical institution where you go to see a doctor.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.