How to reimburse the children's medical insurance card clinic?

The outpatient reimbursement process of children's medical insurance card is as follows:

1. Pay the medical expenses first, and then submit the bills for reimbursement;

2. Reimbursement with bills or direct settlement with social security in hospitals;

3, referral settlement, after the end of medical treatment, the insured or other agents to referral approval form, medical records, prescriptions and valid documents to the medical insurance agencies for reimbursement of hospitalization expenses belonging to the scope of the overall fund payment.

Rules for the use of medical insurance cards:

1. Activation and loss reporting of medical insurance cards: newly received medical insurance cards need to be activated before they can be used; If the medical insurance card is lost, it is necessary to report the loss in time and apply for a replacement card;

2. Recharge and query of medical insurance card: medical insurance card needs to be recharged before it can be used in hospital; Cardholders can check the balance and consumption records through self-service terminals or related platforms;

3. Scope of use of medical insurance cards: Medical insurance cards can usually only be used in designated medical institutions, and may only cover some medical services and medicines;

4. Annual settlement of medical insurance card: Medical insurance accounts usually have provisions for annual settlement, and unused funds may be cleared or rolled into the next year;

5. Personal account and overall account of medical insurance card: medical insurance card is divided into personal account and overall account, and the conditions and scope of use of the two may be different.

To sum up, the outpatient reimbursement process of children's medical insurance card includes first paying medical expenses and keeping bills, and then choosing bills for reimbursement or hospital social security for direct settlement. In the case of referral and transfer, after the medical treatment, the insured or agent will apply to the medical insurance agency for reimbursement of hospitalization expenses within the scope of the overall fund with relevant approval forms and supporting materials.

Legal basis:

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

Article 23

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.