What materials do medical insurance agents need for reimbursement?

1. The following information shall be provided for reimbursement:

1, special invoice and summary list of hospitalization expenses (stamped with the official seal of the hospital).

2, disease diagnosis certificate or discharge summary (build official seal of the hospital).

3. Copy of personal ID card.

4. For the social security card of the insured, the financial account must be enabled (if there is no social security card, the original bank account and ID card of the insured shall be provided). I or entrust others to bring relevant materials to Lianjiang Medical Insurance Bureau to apply for reimbursement within this year as far as possible.

2. Under what circumstances can I manually reimburse the medical expenses paid in full through the unit or social security office?

1. The insured fails to issue a card after enrollment, fails to hold a card for emergency treatment, presses the card at the time of hospitalization and discharge settlement, replaces the social security card, and goes to see a doctor during the unit's arrears.

2. Designated pharmacies failed to make real-time settlement due to medical insurance system problems when purchasing drugs, which met the payment conditions of medical insurance fund.

3. Medical expenses for prenatal examination and family planning outpatient operation.

4. Medical expenses for medical treatment in different places that meet the requirements of Beijing medical insurance.

In the above situation, the individual pays the medical expenses in full, keeps the receipt, prescription, diagnosis certificate and other materials issued by the hospital, and submits them to the district medical insurance agency for manual reimbursement.

Three, the insured how to apply for manual reimbursement of medical expenses paid in full?

1. Urban workers' medical insurance participants will submit the materials to their units for manual reimbursement procedures (retirees have chosen to be reimbursed by the nearest social security office, and individuals can go to the social security office for reimbursement);

2. The insured persons of urban and rural residents' medical insurance will hand over the materials to the social security office of the insured place or residence for manual reimbursement procedures.

4. How does the employee's unit or social security office handle manual reimbursement for the insured?

The social security enterprise software used by the unit or social security inputs the medical expense bill information of the insured person, forms an electronic offer document, prints the corresponding declaration form, and forms a complete declaration material together with the relevant documents provided by the insured person. The staff will submit the electronic version of the offer document and the paper application materials to the medical insurance agency in the insured area.

legal ground

Social insurance law

Article 23

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