How to reimburse medical insurance in different places in Shanghai?

For medical insurance in different places in Shanghai, you need to provide medical insurance card, ID card, hospitalization certificate or outpatient settlement certificate, and choose two ways: direct settlement or reimbursement at your own expense first. At the same time, using medical insurance in different places under the premise of social security card also needs to pay certain medical expenses. The specific operation process can be found on the website of "Shanghai Social Insurance Administration".

Shanghai medical insurance policy supports medical treatment in different places. Specifically, holders of Shanghai medical insurance cards can enjoy medical insurance reimbursement in different places when they visit primary medical institutions and public hospitals at or above the second level in the country. You need to bring your ID card, medical insurance card, hospitalization certificate or outpatient settlement certificate and other relevant documents when you go to see a doctor. Among them, some hospitals may restrict the place or time of medical treatment and need to consult in advance. There are two ways to use medical insurance in different places in Shanghai: one is direct settlement, that is, direct settlement with social security card in the hospital; The other is to reimburse at one's own expense, that is, the hospital collects all the expenses first, and the patient pays in advance, and then carries the receipt to the social security agency for reimbursement. It should be noted that when using medical insurance in different places under the premise of social security card, you still need to pay a certain medical treatment fee. The specific amount varies according to the place of medical treatment, which can be found on the website of Shanghai Social Insurance Administration. For some high medical expenses or special circumstances, it is necessary to apply to the unit or the medical insurance agency of the insured place for medical assistance or personal medical assistance for major diseases and other related relief measures.

If you or your family go to a different place for medical treatment, how can you reimburse them? After medical treatment in different places, you can apply for reimbursement at the social security agency in the place where you seek medical treatment. The specific process is as follows: 1. Provide medical certificates (hospitalization certificate, outpatient settlement certificate, etc.). ), medical insurance card, ID card and other documents; 2. Fill in the reimbursement application form; 3. Submit the above materials to the local social security agency, and pay the corresponding outpatient or inpatient deductible line and personal advance expenses according to the regulations; After the audit, the social security agency will directly transfer the expenses that meet the reimbursement standards or return them to the insured in the form of cash or check. It should be noted that the application time for medical insurance reimbursement is generally within 2 years after discharge. In case of disputes related to medical treatment in different places, it is recommended to consult the local medical insurance agency or relevant departments in time.

As a city with relatively perfect national medical insurance policy, Shanghai's operation process is slightly different from other cities, but the overall operation is convenient and fast. Insured people can understand and master the reimbursement policy and application process, so as to get the related expenses reimbursement in time when they seek medical treatment in different places.

Legal basis:

Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations.