Shanghai medical insurance reimbursement process is how

When it comes to protection, the first thing that comes to mind for many people is health insurance, nowadays the coverage of health insurance has been very large, almost everyone has a health insurance card, and those who have health insurance can be reimbursed within the scope of reimbursement.

A, health insurance reimbursement need what materials?

The main materials needed to apply for reimbursement are: the original original charge data sheet; the original cost breakdown; a copy of the original outpatient medical records; the original diagnosis; emergency hospitalization, you need to issue a certificate of emergency hospitalization; a copy of the original social security card; a copy of the original ID card (entrusted to another person to do the work should also provide the identity of the person who did the work); a copy of the original bank account (passbook or bank card can be); the unit certificate (this is some kind of bank book or bank card) The original copy of the bank account (passbook or bank card is fine); the original copy of the certificate of the organization (this is a specific document required by certain companies for reimbursement, but most of the general workers do not need to provide it) and so on.

It is worth reminding you that when handling these materials, you must ensure the authenticity and reliability of the materials, especially personal identification documents and materials, which must be owned by the applicant himself, so as not to delay the result of the reimbursement application.

Second, what is the process of reimbursement of medical insurance?

First of all, the applicant is required to apply for reimbursement first, and then, submit the relevant application materials required for reimbursement, the place of submission of materials in the participant's required Social Security Fund Administration of the Social Security Branch of each sub-district of the Medical Insurance Section.

After receiving an application for reimbursement, the receiving department of the Administration will check the documents provided by the applicant within five days from the date of receipt of the documents and decide on the final acceptance result.

If the application materials are incorrect or incomplete, the receiving department will notify the applicant and tell him/her to prepare the required materials within 5 days and correct any errors in the materials.

Applicants are required to complete the corrections within 5 days from the date of receipt of the "Notice of Correction". If the deadline is exceeded, the application will not be corrected and will be withdrawn.

If the corrections are completed within the deadline, the application can be resubmitted within the validity period of the Shenzhen health insurance reimbursement.

If the verification process is correct, the application for reimbursement is complete and the applicant can be reimbursed after receiving the Social Health Insurance Medical Expense Reimbursement Form.

3. What is the scope of reimbursement for employee health insurance? What can't be reimbursed?

Questions:

Our unit has a colleague above who had appendicitis before, and then she went to do the operation cost more than 1,000 yuan, I would like to know more than 1,000 yuan of medical expenses can be reimbursed? The unit is purchased medical insurance, may I ask, medical insurance reimbursement scope includes what? Can I get a reimbursement?

Lawyer's reply:

Hello, the medicines included in the basic medical insurance coverage are divided into two categories: Class A and Class B. The Class A medicines are the national basic medicines. Class A drugs are those that are basically uniform throughout the country and can guarantee the basic needs of clinical treatment. The cost of these drugs is included in the basic medical insurance fund, and the cost is paid according to the basic medical insurance payment standard. The catalog of Class B drugs is adjusted by provinces, autonomous regions and municipalities directly under the central government in accordance with their own conditions. These drugs are first paid for by employees at a certain percentage before being included in the scope of payment of the basic medical insurance fund and the costs are paid according to the basic medical insurance payment standards. The reimbursement of basic medical insurance medical service facilities covers the living service facilities provided by designated medical institutions, which are necessary for the diagnosis, treatment and care of insured persons, mainly including hospitalization bed fees or outpatient (emergency) observation bed fees. The costs of living service items and service facilities that are not paid by the basic medical insurance fund mainly include: (1) transportation fees for consultation (transfer) and emergency vehicle fees; (2) air-conditioning fees, television fees, telephone fees, infant warming box fees, food warming box fees; (3) escort fees, nurse's fees, washing and cleaning fees, and outpatient decoctions fees; (4) meal fees; and (5) recreational and cultural activities fees and other special living service fees.

Social Insurance Law

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly by the social insurance administration organization with the medical institutions and the drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.

Social Insurance Law

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly by the social insurance administration agencies with medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.