Where to go for outpatient reimbursement for urban and rural residents

Choose the right place for reimbursement and prepare the relevant materials.

I. Understanding the regulations of the place of participation

The specific regulations of outpatient reimbursement for urban and rural residents may vary from region to region, so you need to understand the relevant policies of the place of participation first. You can get detailed information by consulting the local social security department, medical institutions, or reviewing the relevant policy documents.

Selecting a reimbursement location

1. Designated medical institutions: Most regions have designated medical institutions where participants can go for outpatient treatment and be reimbursed directly after the treatment. The designated medical institutions usually include community hospitals, township health centers and other primary medical institutions, as well as some hospitals above the county level.

2. Social security departments: If a participant has not visited a designated medical institution, or if the expenses to be reimbursed exceed the limit of a designated medical institution, he or she can go to the local social security department for reimbursement. At the social security department, you need to submit relevant medical expense invoices, prescription slips, diagnostic certificates and other materials, and reimbursement will be made after examination.

Third, prepare the reimbursement materials

In the outpatient reimbursement, the participants need to prepare the following materials:

1, medical cost invoices: including the invoices of drug costs, examination costs, treatment costs and other costs.

2. Prescription list: a prescription list issued by a doctor, which should indicate the name of the medicine, dosage, usage and other information.

3, Diagnostic certificate: Diagnostic certificate issued by the doctor, need to indicate the condition, treatment recommendations and other information.

4, ID card and social security card: used to verify the identity of the participant and the information of participation.

4. Notes

1. Keep the original bills: all bills used for reimbursement need to be kept properly to avoid loss or damage.

2. Pay attention to the time limit for reimbursement: different regions may set different time limits for reimbursement, and participants should complete the reimbursement procedures within the specified time.

3. Know the reimbursement rate and limit: Different regions and different types of health insurance may have different reimbursement rates and limits, and participants should know the relevant regulations in advance.

In summary:

The location and process of outpatient reimbursement for urban and rural residents vary according to the region and the type of insurance a person is enrolled in. Participants should understand the regulations of the place of participation, choose a suitable reimbursement location and prepare relevant materials. During the reimbursement process, pay attention to keeping original bills, observing the time limit for reimbursement, and understanding the reimbursement rate and limit.

Legal basis:

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

Article 28 stipulates that:

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

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

Article 29 stipulates:

The portion of a participant's medical expenses that should be paid out of the basic medical insurance fund shall be settled directly between the social insurance agency 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.