How long can the medical insurance be used after it is paid, and can the medical expenses be reimbursed during the period?

If the medical insurance of the insured employees is interrupted, they will no longer enjoy the medical insurance reimbursement treatment from the second month after the interruption. If the deadline is within three months, as long as the employer and individual employees pay in time, the medical expenses incurred within three months after the deadline can be reimbursed; If the payment is suspended for more than three months, even if the employer and individual employees pay the medical expenses, the medical expenses incurred during this period cannot be reimbursed, and they can only enjoy the medical reimbursement treatment from the second month after payment.

If the unit pays more than six months and then pays back, the medical expenses incurred during the payment period cannot be reimbursed, but the medical expenses can be reimbursed normally from the second month after payment, but the payment period can not be calculated as continuous years, but can only be calculated as cumulative payment period.

Flexible employees participate in medical insurance for urban employees and pay medical insurance for employees for the first time. According to the local medical insurance system, it takes six months for medical expenses to be reimbursed; If a flexible employee or on-the-job employee continues to pay employee medical insurance as a flexible employee after leaving office, if payment is stopped within three months, the medical expenses incurred during this period can be reimbursed normally as long as they are paid in time. Even if it is paid after three months, the medical expenses incurred during this period cannot be reimbursed, but the continuous payment period can be calculated; If the payment is overdue for more than six months, it will be regarded as re-payment and it will take six months to reimburse the medical expenses. If the continuous payment period is interrupted, it can only be calculated as the cumulative payment period.

The personnel of medical insurance for urban and rural residents are mainly other urban and rural residents who have not participated in employee medical insurance. Medical insurance for urban and rural residents is paid annually, and there is no problem of withholding and remitting for three or six months. However, in some places, it is stipulated that it takes six months for people who participate in medical insurance for urban and rural residents for the first time to reimburse hospitalization expenses, and then they can reimburse hospitalization expenses normally as long as they pay the fees on time every year.

legal ground

Social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.

Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment. Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.