Medical Insurance Reimbursement Process for Off-site Surgery

The reimbursement process of medical insurance for off-site surgery is as follows:

1, go through the registration formalities for medical treatment in different places at the medical insurance handling department of the insured place;

2. If the medical insurance network settlement is realized between the insured place and the medical treatment place, the personnel who need medical treatment in different places can brush the medical insurance card at the medical treatment place for medical treatment according to the relevant provisions of local medical insurance, and directly settle the medical expenses after handling the medical treatment procedures in different places;

3. For the case that online settlement is not realized, the insured person needs to bring discharge summary, invoice, medication list issued by different hospitals, diagnosis certificate issued by the unit and other materials to the local social security agency for reimbursement;

4. After approval, the medical insurance fund will be credited to the personal account.

Provisions on the cross-regional use of medical insurance:

1. Cross-regional use conditions of basic medical insurance: it is necessary to meet the requirement that the insured person can seek medical treatment in different places after paying social medical insurance premiums for a certain period of time in the insured place;

2. Filing process for medical treatment in different places: Before seeking medical treatment in different places, the insured shall file with the social medical insurance management institution in the insured place;

3. The scope of direct settlement of medical treatment in different places: usually including emergency, outpatient special diseases and hospitalization, but the specific policies vary from region to region;

4. The reimbursement rate of medical expenses in different places: the reimbursement rate of medical expenses in different places may be lower than that in the insured place, and there may be differences between the capping line and the deductible line;

5. Settlement process of medical expenses in different places: After receiving medical treatment in different places, the insured shall submit the application for reimbursement of relevant expenses according to the prescribed procedures, including details of medical expenses and invoices issued by medical institutions.

To sum up, the medical insurance reimbursement process for off-site surgery includes going through the registration procedures for off-site medical treatment, swiping the medical insurance card after going through the off-site medical treatment procedures according to regulations, or bringing relevant materials to the local social security agency for reimbursement, and finally crediting the medical insurance fund to the personal account.

Legal basis:

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

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.