Health insurance enrollment is normal but not reimbursed

The problem of normal health insurance participation but not reimbursement often involves a number of factors, including the individual's participation status, the type of medical expenses, reimbursement policy and reimbursement process.

One, verify the status of individual participation

First of all, the participants need to confirm whether their health insurance participation status is normal. This can be verified by checking the health insurance payment records and the status of the social security card. If you find that there are abnormalities in the status of participation, such as arrears, suspension, etc., you need to contact the health insurance agency in time to deal with it.

2. Understanding the types of medical expenses

The reimbursement policy and process will be different for different types of medical expenses. Participants need to know whether the medical expenses they incur are covered by medical insurance, such as hospitalization expenses, outpatient expenses, and drug expenses. At the same time, they also need to pay attention to the existence of medical insurance payment limits, out-of-pocket expenses and other regulations.

Three, familiar with the reimbursement policy and process

Medicare policy has a certain timeliness and geographical, participants need to pay attention to the local health insurance department's policy dynamics, to understand the latest reimbursement policy and process. When applying for reimbursement, they need to follow the prescribed procedures and requirements, such as preparing relevant supporting materials and filling out reimbursement application forms.

Fourth, consult the medical insurance agency

If the participants still can't solve the problem after checking the status of their participation, understanding the types of medical expenses and familiarizing themselves with the reimbursement policy and process, they can contact the local medical insurance agency for consultation and appeal. The health insurance agency will verify and process the case and provide a solution for the participant.

In summary:

The problem of normal but non-reimbursement of health insurance participation needs to be verified and dealt with by the insured in several ways. First, make sure that the individual's participation status is normal; second, understand the types of medical expenses and reimbursement policies; and finally, follow the prescribed procedures and consult the health insurance agency when necessary. Only in this way can you ensure that your health insurance rights and interests are fully protected.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 28 stipulates:

Medical expenses that conform to the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facility standards, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

The Social Insurance Law of the People's Republic of China

Article 30 stipulates:

The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid from the workers' compensation insurance fund;

(2) those that should be borne by a third person;

(3) those that should be borne by the public ****health burden;

(iv) medical treatment outside the country.