Trauma medical insurance reimbursement process

Legal analysis: reimbursement process 1, and the agent submits the reimbursement documents and other materials to the Social Insurance Fund Administration for acceptance; 2. After receiving the application materials, the accepting department will complete the examination, settlement and payment on the same day; 3, the social insurance fund management bureau to review the materials and approve the application, the applicant to receive the "social medical insurance medical expenses reimbursement form", be reimbursed. How to reimburse medical insurance? This is a question that many people want to know now. Medical insurance is the reimbursement ratio of medical expenses: township hospitals reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%. Scope and standard of compensation 1. Out-patient compensation: (1) 60% for visits to village clinics and village center clinics, with the limit of prescription drugs for each visit 10 yuan, and the limit of prescription drugs for temporary rehydration for doctors in health centers in 50 yuan. (2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan. (3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan. (4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan. (5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan. (6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.

Legal basis: Article 23 of the Social Insurance Law of People's Republic of China (PRC), employees shall participate in the basic medical insurance for employees, and the employer and employees shall jointly pay the basic medical insurance premium in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.