How to apply for reimbursement of major diseases

If the medical expenses caused by major diseases are within the scope of the basic medical insurance drug list, medical treatment items and other items and standards, the parties may submit the social security card and other materials to social insurance agencies and medical institutions for reimbursement; Do not meet the requirements, the relevant expenses shall be borne by the parties themselves.

The specific reimbursement methods are as follows:

Medical Records The medical records purchased in this hospital are generally 1 yuan/copy. Medical records generally indicate the diagnosis and treatment plan given by each doctor according to the diagnosis and treatment process. The pain is that the handwriting of ordinary handwritten medical records is illegible. )

Social security card or ID card. If the medical staff has a social security card, they can directly use the social security card for medical treatment, and later they can directly reimburse the expenses in the hospital (some hospitals may not be able to directly reimburse medical treatment in different places). If you don't swipe your medical insurance card, you can prepare the materials later and apply for reimbursement.

Diagnostic proof. Generally, it is a simple medical certificate with the signature of the doctor and the seal of the hospital, which can be divided into two types: printed and handwritten, and can generally be used to call in sick.

Discharge record. When leaving the hospital, it will be provided by the hospital. Generally, the admission time, course of disease, treatment result and discharge time will be indicated. General hospitals will provide 2~3 discharge records (in some places called discharge summary). )

Invoice. Divided into hospitalization invoices and outpatient invoices. General outpatient and emergency invoices are not reimbursed, some special drugs cannot be reimbursed, and reimbursed invoices cannot be reimbursed again.

Expense list. This list will detail every expense from admission to discharge. Some hospitals will take the initiative to provide it, some hospitals need to take the initiative to ask for it, and some hospitals will provide self-printing expense lists.

Other information. This includes CT, DR, MRI and other examination data. It is suggested that all medical materials be stored in a separate bag to avoid trouble after being lost.

Application form for reimbursement. The application form is a document that is easy to handle and approve. General hospitals or social security institutions will have blank forms and templates for reference (the attached drawings are for reference only, and local policies may be different).

Legal basis:

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

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.