Can five insurances and one gold be reimbursed for medical treatment in different places?

Medical insurance in five insurances and one gold can be reimbursed as long as it meets the relevant reimbursement conditions when seeking medical treatment in different places.

I. Overview of five insurances and one gold

Five insurances and one gold refer to the general term of several kinds of indemnificatory benefits given to workers by employers, including endowment insurance, medical insurance, unemployment insurance, work injury insurance, maternity insurance and housing accumulation fund. Among them, medical insurance is an important system to ensure that workers can get medical treatment and economic compensation when they are sick or injured.

The second is the reimbursement conditions for medical treatment in different places.

1. Record of medical treatment in different places: The insured shall record with the social security agency of the insured place before seeking medical treatment, explaining the reason, place and estimated cost of medical treatment. After successful filing, the insured person can enjoy medical insurance reimbursement for medical treatment in different places.

2. Holding valid certificates: the insured person must carry valid certificates such as ID card and social security card to prove his identity and medical treatment.

3. Choose a designated medical institution: the insured person should choose a designated medical institution at the place where he goes to see a doctor. These medical institutions usually have cooperative relations with social security institutions and can directly settle medical expenses.

Third, the reimbursement process

1. Settlement for medical treatment: When the insured person goes to the designated medical institution for medical treatment, he should directly use the social security card for settlement, and the medical institution will deduct the corresponding expenses according to the medical insurance policy.

2. Reimbursement application: For some expenses that cannot be settled directly, the insured can apply for reimbursement to the social security agency in the insured area and provide relevant supporting materials, such as medical expense invoices and diagnosis certificates.

3. Review and payment: The social security agency will review the reimbursement application and pay the reimbursement to the insured after confirming that it meets the reimbursement conditions.

To sum up:

Medical insurance in five insurances and one gold can be reimbursed as long as it meets the relevant reimbursement conditions when seeking medical treatment in different places. Insured persons need to file in advance for medical treatment, choose designated medical institutions, and directly use social security cards for settlement when seeking medical treatment. For some expenses that cannot be settled directly, you can submit an application for reimbursement to the social security agency of the insured place.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 29 provides that:

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.

Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers

Article 26 provides that:

The basic medical insurance fund and individual account shall delimit their respective payment ranges, account for them separately, and shall not occupy each other.

(a) the personal account is used to pay the basic medical expenses of outpatient service and other expenses paid by individuals according to regulations;

(two) the overall fund is used to pay the basic medical expenses for hospitalization; The basic medical expenses of specific outpatient items and the outpatient medical expenses of special diseases approved to be included in the payment scope of the overall fund.