Jiujiang medical insurance reimbursement policy

The reimbursement scope of Jiujiang medical insurance:

I. Scope of reimbursement

1, insured employees or residents are treated in designated medical institutions (including family beds).

2, the insured in the designated medical institutions, retail pharmacies.

Second, the scope of non-reimbursement

1, in non-designated medical institutions.

2. Treatment of injuries caused by traffic accidents, medical accidents or other accidents.

3, because I take drugs, fighting or other illegal acts caused by injury treatment.

4, due to suicide, self-mutilation, alcoholism and other reasons to receive treatment.

5. Go abroad or go to Hong Kong, Macao and Taiwan for medical treatment.

6. Various health checkups and entrance checkups.

7. Myopia correction

8, all kinds of weight loss, weight gain, increase the project

9, all kinds of expensive vaccines and vaccination fees

10, Treatment of Congenital Disability

1 1. Others shall be paid by individuals according to regulations.

Jiujiang hospitalization expenses reimbursement materials:

Social security card (without social security card, provide resident ID card and bank card);

Hospital bills;

Proof of disease diagnosis;

Summary of expenses;

Hospitalization medical records;

Proof materials of designated medical institutions for medical insurance (only the staff of designated medical institutions for medical treatment in different places who are not directly settled by inpatient medical institutions will be cancelled after the establishment of the national designated medical institutions information database);

Accidental injury has no relevant proof of third-party liability or personal commitment letter (only provided by accidental injury personnel);

Emergency related certificates; Emergency record form

Legal basis: social insurance law

Article 28

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

Article 29

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.

Article 30

The following medical expenses are not included in the scope of payment of the basic medical insurance fund: (1) those that should 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.

Article 32

If an individual is employed across the overall planning area, his basic medical insurance relationship will be transferred accordingly, and the payment period will be calculated cumulatively.