Can out-of-town emergency room expenses be reimbursed?

Out-of-town emergency room expenses can be reimbursed.

The cost of an out-of-town emergency room visit can be reimbursed, usually at a rate of sixty percent, but this may vary by region. If you are hospitalized off-site, you will need a local referral form, otherwise the reimbursement rate may be reduced by about twenty percent. After being hospitalized in a foreign hospital, you can apply for reimbursement at the medical insurance agency with your hospitalization documents, medical insurance card, ID card and other relevant documents. If you are hospitalized abroad due to a sudden illness, you can apply for reimbursement after being discharged from the hospital by bringing only your medical records and proof of absence. Participants who live abroad for a long time can also go back to their domicile with the relevant information for reimbursement, or entrust others to do it on their behalf.

The reimbursement process of social security:

1. Prepare relevant materials: including ID card, social security card, list of expenses and invoice issued by the hospital, and summary of medical records;

2. Submit reimbursement application: bring the materials and submit them to the social security agency in the place of domicile or to the designated window of medical reimbursement;

3. Audit the materials: social security agencies will audit the submitted materials and ensure that the expenses are covered. materials to ensure the authenticity and compliance of the expenses;

4. Expense accounting: according to the local social security policy and the individual's social security contributions, calculate the reimbursable expense ratio and amount;

5. Reimbursement approval: after passing the audit, the social security agency will approve the reimbursement amount;

6. Expense disbursement: after passing the approval, the reimbursed expense will be disbursed to the bank account designated by the individual.

In summary, the cost of out-of-town emergency room visits can be reimbursed, and the reimbursement rate is usually 60%, but it should be noted that it may vary from region to region. A referral form is required for hospitalization abroad, otherwise the reimbursement rate may be reduced by 20%. After being hospitalized abroad, bring the relevant information to the medical insurance agency to apply for reimbursement. After seeking medical treatment for a sudden illness, you only need to bring your medical records and proof of absence to apply for reimbursement. Participants who live abroad for a long time can return to their domicile for reimbursement or entrust others to do it on their behalf.

Legal basis:

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

Article 28

Medical expenses that are in line with the drug list, diagnostic and therapeutic items, and standards of medical service facilities of the basic medical insurance as well as those for emergency treatment and salvage, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.