How to reimburse medical insurance after hospitalization?

How to reimburse medical insurance after hospitalization is as follows:

1. When entering or leaving the hospital, you must go through the registration formalities with the medical insurance IC card at the medical insurance management window of each designated medical institution. Personal hospitalization should pay 2000 yuan in advance for medical expenses, and make up for it more or less after discharge. The medical expenses incurred before the hospitalization registration formalities shall not be included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, the emergency certificate should be used to go through the hospitalization formalities at the medical insurance management window the next day after admission, and the overdue medical expenses should be borne by themselves;

2. After the insured is hospitalized, the deductible line of the overall fund is divided into three grades: tertiary hospital 1000 yuan, secondary hospital 600 yuan, and primary hospital 400 yuan. In a basic medical insurance settlement year, the cumulative calculation of medical expenses for multiple hospitalizations;

3. If the insured person needs to be referred due to illness, the deputy chief physician or chief physician of the designated medical institution shall put forward the referral opinions after diagnosis, and the unit to which he belongs shall fill in the application form, and go through the referral procedures after being audited by the medical insurance management department of the designated medical institution and reported to the municipal social security institution. The transfer is limited to provincial specialized hospitals, and the expenses are paid by me first. The reimbursement standard is 10% first, and then the reimbursable amount is calculated according to local regulations.

4. When the designated medical institutions are discharged from the hospital, the reimbursement amount and the amount payable by individuals shall be calculated by the designated medical institutions, and the reimbursement amount shall be settled by the designated medical institutions and urban social insurance agencies, and the amount payable by individuals shall be settled by the designated medical institutions and the insured.

Information to be provided for reimbursement of hospitalization medical expenses:

1, copy of IC card and ID card for medical insurance reimbursement;

2. Original invoice for regular hospitalization;

3, stamped with the seal of the hospital medical expenses summary list;

4. Discharge certificate or diagnosis certificate;

5, stamped with the seal of the hospital medical records copy;

6. Medical personnel who are transferred to other places for reimbursement of medical expenses need to bring social insurance referral application forms when hospitalized in other places; Resettlement personnel reimbursement of medical expenses also need to carry a copy of the "application form for urban workers' basic medical insurance resettlement personnel"; Insured persons who are hospitalized in this city also need to carry the reasons issued by the hospital for failing to pass the system settlement.

To sum up, medical insurance reimbursement is reimbursement after discharge or transfer. Settlement procedures for hospitalization and outpatient treatment of special diseases: Before 10 every month, the designated medical institutions will report the expense list, hospitalization list and related materials of the patients discharged last month to the medical insurance agency, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination; Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.

Legal basis:

Article 29 of People's Republic of China (PRC) Social Insurance Law

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.