How to reimburse medical insurance for hospitalization in different places

The reimbursement methods for hospitalization medical insurance in different places are as follows:

1, personnel seeking medical treatment in different places shall go through the registration procedures for medical treatment in different places first;

2, after the medical treatment, with the relevant bills to the insured medical insurance agencies for reimbursement procedures;

3. If the medical insurance network settlement is realized between the insured place and the medical treatment place, the medical expenses can be directly settled by swiping the medical insurance card at the medical treatment place.

Medical insurance reimbursement scope:

1. Insurance liability for hospitalization medical expenses within the scope of medical insurance, as well as some expenses in the medical insurance catalogue that are still borne by individuals after being reimbursed by basic medical insurance, serious illness insurance and medical assistance. , shall bear the liability for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,10.5 million free of compensation, the reimbursement rate is 80%, and the reimbursement rate for continuous participation is increased to 85%;

2. The insurance liability of hospitalization medical expenses outside medical insurance coverage, as well as the part that is still borne by individuals after the expenses outside the medical insurance catalogue are reimbursed by basic medical insurance, serious illness insurance and medical assistance, shall be liable for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,1.8,000 free of compensation, the reimbursement rate is 60%, and the reimbursement rate for continuous participation is increased to 65%;

3, outpatient specific high drug costs insurance liability, in designated hospitals, designated pharmacies, drug costs borne by individuals, within the agreed scope of insurance liability, bear the liability for compensation. 700,000 insured amount, 26 kinds of drugs, and 20,000 yuan shared with the insurance responsibility of outpatient drugs/hospitalization medical insurance expenses for rare diseases, with a compensation ratio of 80%;

4. Designate the insurance liability of outpatient drugs for rare diseases/hospitalization medical insurance expenses, and pay part of the drug expenses paid by individuals in designated hospitals and pharmacies within the agreed scope of insurance liability. 300,000 insured amount, 12 drugs, sharing 20,000 yuan with the insurance responsibility of outpatient specific high drug expenses, and the reimbursement ratio is 70%.

To sum up, basic medical insurance (including basic medical insurance for urban workers and basic medical insurance for urban and rural residents) is closely related to inclusive prices. Focus on ensuring the high medical expenses caused by major diseases and accidental injuries, and provide more adequate protection for major diseases. Compared with general commercial insurance, there are no restrictions on the age and occupation of the insured, and the health conditions are more tolerant. At the same time, the treatment cost of 20 kinds of high-priced specific drugs and 10 kinds of designated rare diseases drugs outside the medical insurance catalogue has been expanded.

Legal basis:

Article 2 of People's Republic of China (PRC) Insurance Law

The term "insurance" as mentioned in this Law refers to the commercial insurance behavior in which the applicant pays the insurance premium to the insurer according to the contract, and when the insured dies, suffers from disability, illness or reaches the age and time limit agreed in the contract, the insurer shall be liable for the property losses caused by the possible accidents agreed in the contract.

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This Law is applicable to insurance activities in People's Republic of China (PRC).

Article 5

The parties to insurance activities shall exercise their rights and perform their obligations in accordance with the principle of good faith.