Where can employee medical insurance be reimbursed?

Employees' medical insurance reimbursement needs to go to the local social security bureau or medical insurance bureau for reimbursement. Social medical insurance participants can directly use the medical insurance card for reimbursement in the hospital, or go to the local social security institution or medical insurance bureau for reimbursement.

The places where employees are reimbursed for medical insurance are as follows:

1. If the patient is hospitalized in a local designated medical insurance institution, the hospital will automatically reimburse him when he leaves the hospital.

2. If you are not hospitalized and have not been reimbursed for medical treatment, you need to bring the hospitalization settlement invoice, medical certificate, expense details and social security card to the local government affairs center or the medical insurance window of the social security center for reimbursement; If you are treated in other medical institutions, you need to provide a referral certificate.

The proportion of medical insurance reimbursement for employees is as follows:

1. hospitalization reimbursement:185% of medical expenses from 300 yuan to RMB 30,000, 90% from RMB 30,000 to RMB 40,000, and 95% from RMB 40,000 to RMB 65,438+10,000.

2. Outpatient reimbursement: The reimbursement rate for community outpatient service is 90%, and that for non-community outpatient service is 70%. Outpatient reimbursement deductible line 1800 yuan, with a maximum reimbursement amount of 20,000 yuan.

Off-site reimbursement

If you want to directly reimburse and settle medical insurance in different places, you need to go through these processes first:

You need to register for the record first and choose a designated medical institution.

Then take the card to see a doctor.

Reimbursement requires a copy of the original ID card, a copy of the original rural cooperative medical card, a hospitalization certificate, a bill of charges during hospitalization, a bill of total charges at discharge, and a copy of the medical record of the diagnosis certificate.

For reimbursement in different places, just take your ID card, medical card and discharge document. If you haven't been reimbursed in different places, you need to get back the hospitalization documents and go to the medical hall managed by the local social security bureau or the medical management hall of the medical insurance bureau for reimbursement.

Pay attention to the following points when seeking medical treatment in different places:

First, direct settlement of medical treatment in different places is aimed at the insured of basic medical insurance.

Two, the direct settlement of medical treatment in different places is suitable for inpatients, not for outpatients.

Three, during the hospitalization of patients, medical insurance payment status shall not be interrupted, otherwise it will not be able to pay by credit card.

Fourth, at present, only the amount of social security card can have the function of inter-provincial medical treatment.

I hope the above content can help you. Please consult a professional lawyer if you have any other questions.

Legal basis: Article 28 of the 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.