Can you get direct reimbursement for medical treatment in Beijing?

Whether or not you can be reimbursed directly depends on the health insurance policy of the place of participation and whether or not you have realized the health insurance network settlement with Beijing.

First, you need to understand the health insurance policy of the place of participation

First of all, you need to understand the health insurance policy of the place of participation, including whether it supports the direct settlement of medical treatment in other places, the reimbursement rate, the scope of reimbursement, etc. Different regions may have different health insurance policies, so this is a very important step. This step is crucial as health insurance policies may vary from region to region.

The second step is to apply for the record of medical treatment in other places

Before traveling to Beijing for medical treatment, you need to apply for the record of medical treatment in other places in the place where you are insured. This procedure is usually carried out at the medical insurance agency or social security department of the place of participation, and can only take effect after the submission of relevant materials and review. Only after the filing procedures are completed can you enjoy the direct settlement service of medical insurance at the designated medical institutions in Beijing.

Third, choose the designated medical institutions in Beijing

When seeking medical treatment in Beijing, you should choose the designated medical institutions with the qualification of medical insurance network settlement. These medical institutions will usually have the medical insurance settlement window prominently displayed, making it easier for patients to go through the reimbursement procedures when seeking medical treatment.

Fourth, hospitalization and expense settlement

When you go through the hospitalization procedure at the selected medical institution, you are required to present a valid ID card, social security card and other relevant supporting documents. Medical expenses incurred in the process of medical treatment will be reimbursed directly through the medical insurance network settlement system if they meet the requirements of the medical insurance. Patients will only need to pay the individual out-of-pocket portion.

Fifth, pay attention to the reimbursement time limit and material preservation

The reimbursement for medical treatment in other places usually has a certain time limit, so you need to apply for reimbursement procedures within the specified time. At the same time, it is necessary to properly save the relevant bills and supporting materials in the process of medical treatment, in order to prepare for the subsequent reimbursement audit.

In summary:

Whether you can get direct reimbursement for medical treatment in Beijing depends on the health insurance policy of the place where you are insured as well as whether you have realized the networked settlement of health insurance with Beijing. Before seeking medical treatment, you need to understand and comply with the relevant regulations of the insured place, go through the procedures of filing a record of medical treatment in a different place, and choose a designated medical institution with the qualification of medical insurance network settlement to seek medical treatment. In the process of medical treatment, pay attention to keep the relevant bills and supporting materials for subsequent reimbursement audit.

Legal basis:

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

Article 29 stipulates that:

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

Guiding Opinions of the General Office of the State Council on Promoting the Construction of a Graded Diagnosis and Treatment System

Article 4 stipulates:

Promote the settlement of settlement for medical treatment in different places. Accelerate the establishment of the mechanism for the network settlement of medical treatment in other places, and promote the direct settlement of medical expenses for medical treatment in other places for basic medical insurance.