How to reimburse employees for outpatient services

Steps such as understanding the policy, preparing materials, submitting an application, waiting for review and settlement, and receiving reimbursement are required.

When an employee goes to the outpatient clinic, he or she can be reimbursed according to certain rules and procedures.

I. Understanding outpatient reimbursement policy

Before an employee seeks outpatient medical treatment, he or she should first understand the outpatient reimbursement policy of his or her region, including reimbursement rate, reimbursement scope, reimbursement limit, and so on. This information can be obtained through the unit's personnel department, social security organization or health insurance department.

Second, prepare the necessary materials for reimbursement

When employees visit outpatient clinics, they should keep the relevant invoices and vouchers, including outpatient medical records, invoices, prescription slips, etc. These materials are important for outpatient reimbursement. These materials are an important basis for outpatient reimbursement and must be kept in a safe place.

Third, submit the reimbursement application

After the medical treatment, the employee should submit the necessary materials for reimbursement to the personnel department of his/her organization or social security institution according to the specified time and place. When submitting, they should ensure that the documents are complete and accurate so as not to affect the progress of reimbursement.

Fourth, wait for the audit and settlement

After receiving the employee's reimbursement application, the unit's personnel department or social security organization will conduct a preliminary audit and forward the relevant materials to the medical insurance department for further audit and settlement. Employees need to wait patiently for the results of the audit and, if necessary, supplement the relevant materials as required.

V. Receiving reimbursement

After the audit is approved, the health insurance department will credit the reimbursement directly to the employee's health insurance account or designated bank account. Employees can check the status of the reimbursement through the relevant channels.

In summary:

Employee outpatient reimbursement requires understanding the policy, preparing materials, submitting an application, waiting for review and settlement, and receiving reimbursement. During the reimbursement process, employees should comply with the relevant regulations and procedures to ensure the smooth progress of reimbursement. At the same time, the personnel department of the unit and the social security agency should also actively assist the employee to complete the reimbursement work to protect the legitimate rights and interests of the employee.

Legal basis:

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

Article 28 stipulates that:

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

The Labor Law of the People's Republic of China

Article 73 stipulates:

Laborers are entitled to social insurance benefits in accordance with the law in the following circumstances: (1) retirement; (2) illness or injury; (3) work-related disability or occupational disease; (4) unemployment; and (5) childbirth. When a worker dies, his or her survivors are entitled to survivor's benefits in accordance with the law. The conditions and standards under which workers are entitled to social insurance benefits are set forth in laws and regulations. The social insurance benefits enjoyed by workers must be paid in full and on time.