How to reimburse personal medical insurance?

The process of individual payment for medical insurance reimbursement is as follows:

1, local hospitalization reimbursement:

(1) The applicant has gone through the insurance formalities and paid the medical insurance premium in full;

(2) the cooperative medical system designated medical institutions for medical treatment;

(3) The insured shall pay in advance the hospitalization expenses incurred in the medical institution for the record, and keep the relevant documents and materials;

2, off-site hospitalization reimbursement:

(1) If the insured person is sick in a tertiary hospital (or specialized hospital) in this city, it is difficult to make a diagnosis or there is no treatment, and he may apply for hospitalization in another place;

(2) transfer must fill in the application form, signed by the designated hospitals above the third level in our city, and reported to the municipal medical insurance agency for review and filing before being transferred for treatment;

(3) Insured persons who need to be hospitalized in different places should be hospitalized in local designated medical institutions, and the municipal medical insurance center should be notified by telephone within 3 days after admission;

(4) Transfer and emergency medical expenses in different places shall be paid by individuals first, and shall be reimbursed to the municipal medical insurance center within one month after discharge;

3, outpatient reimbursement:

(1) If the insured person is sick in a tertiary hospital (or specialized hospital) in this city, it is difficult to make a diagnosis or there is no treatment, and he may apply for hospitalization in another place;

(2) transfer must fill in the application form, signed by the designated hospitals above the third level in our city, and reported to the municipal medical insurance agency for review and filing before being transferred for treatment;

(3) If the insured suffers from common diseases and needs outpatient medical treatment, he can go to a designated medical institution nearby for medical treatment. Within a settlement year, the outpatient Qifubiaozhun will be lowered for the second time, and the second outpatient Qifubiaozhun will be 50% of the first Qifubiaozhun, and the above part of Qifubiaozhun will be borne by the individual;

(4) The medical expenses shall be reimbursed in accordance with the regulations if the outpatient doctor issues a prescription or the medical institution doctor issues a prescription stamped with the foreign seal.

Medical insurance reimbursement conditions:

1. Confirm the insured status: before seeking medical treatment, you need to confirm that you have participated in local medical insurance, which can be confirmed by means of social security card and medical insurance certificate;

2. Medical category: Medical insurance generally only reimburses therapeutic medical behaviors, such as outpatient service, hospitalization, surgery and examination. Some cosmetic medical behaviors, such as dental beauty and plastic surgery, are usually not covered by medical insurance reimbursement;

3. Medical expenses: Medical insurance will only reimburse medical expenses that meet the requirements, such as medical expenses, medicine expenses, examination expenses, operation expenses, etc. Personal expenses, medical insurance will not be reimbursed;

4. Hospital qualification: Medical insurance will only reimburse the medical expenses of legally operated medical institutions, such as public hospitals and qualified private hospitals. Medical insurance will not be reimbursed for illegal medical institutions or clinics.

To sum up, you can consult your local medical insurance institution or stomatological hospital.

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.