How to reimburse the medical insurance outpatient service for retired workers

The reimbursement process of medical insurance outpatient service for retired employees is as follows:

1. Every month 1- 19, the retirees submit the prepared drug expense documents and materials to the drug expense reimbursement window in the lobby of the social security office;

2. The staff of the social security office will collect the documents that meet the reimbursement conditions after the audit, and let the retirees fill in the registration form in duplicate, one for the retirees and one for the social security office, and make records;

3. Bind and provide the recorded medical expense documents, and the staff will send the medical expense documents and social security cards to the district medical insurance center for declaration;

4. Take back the social security cards of retirees who have passed the examination and given reimbursement, and let individuals sign for them;

5. Return the drug bills and social security cards that do not meet the reimbursement requirements, and inform the retirees of the materials that need to be supplemented or the reasons for not being reimbursed, and then resubmit them to the medical insurance center after the retirees complete them;

6. For retirees who are reimbursed by the unit for the second time, after the drug expenses reimbursed by the unit reach the retirement medical insurance passbook, they will be registered by themselves, and the staff will print the manual reimbursement approval form at the district medical insurance center.

After retirement, medical insurance shall be handled in the following ways:

1. Bring the sorted files and some retirement forms (with official seals) to the audited files of retirement approval business on the first floor of the Social Security Center. Time: 1 till the end of each month;

2. After the file is approved, submit the waiver form to the counter next to the four risks collection for liquidation and print the liquidation form (in triplicate), which requires social security seal;

3. Prepare two copies of the pension approval form, the liquidation form and the second-generation ID card of retirees, and submit them to the payment department for an increase form (to ensure the payment of pensions from the date of examination and approval) in duplicate;

3. Calculate the retirement fee (i.e. pension approval form) in the software according to the liquidation form, and make an on-the-job retirement form in the "medical" software and affix its seal;

4, in the software to calculate the pension approval form in six copies, stamped with the official seal;

5. Submit the pension approval form in six copies to the social security "retirement approval" counter (that is, the counter before the file review) for review, and stamp it after review. Special retirees, leave a "liquidation form", "pension approval form" and "publicity" to the "retirement approval" counter;

6. Give it to the Medical Insurance Office: just fill in the header and sign the Approval Form for Determining the Equivalent Payment Period of Basic Medical Insurance, and fill in the rest at the counter;

7. The forms to be submitted at the medical counter include: approval form for determining the payment period of basic medical insurance, approval form for retirement of basic medical insurance, approval form for pension, reduction form for social insurance personnel, application form for early retirement or file audit record form;

8. Submit 1 photos, print the inner page of the medical insurance manual (stamped with steel seal), and update the social security card at the same time;

9. After the following month 12, go to the social security "payment department" to get the passbook. The initial password of the card is 6 digits after the ID card;

10. Send the retirement certificate, the inner page of the medical insurance manual, the social security card and the pension passbook/card to the retirees.

To sum up, retirees submit the prepared drug expense documents and materials to the drug expense reimbursement window in the lobby of the Social Security Institute every month 1- 19.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should jointly pay the basic medical insurance premiums 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.