Can accidental hospitalization insurance be reimbursed?

Accidental hospitalization can be reimbursed by medical insurance.

First, the scope of medical insurance reimbursement

The reimbursement scope of medical insurance usually includes basic medical expenses, hospitalization expenses, operation expenses and medicine expenses. When the insured is hospitalized due to accidental injury, related expenses, such as bed fee, nursing fee, examination fee, treatment fee, etc. Those who meet the medical insurance policy can be reimbursed according to a certain proportion.

Second, the reimbursement process

After the insured person is hospitalized unexpectedly, he/she should go through the hospitalization formalities according to the requirements of the hospital, and properly keep the invoices and documents of relevant medical expenses. When you leave the hospital, you can go to the medical insurance window of the hospital to settle the expenses and apply for reimbursement. The hospital will conduct a preliminary examination of the expenses of the insured according to the medical insurance policy, and issue a list of relevant expenses and reimbursement vouchers.

Insured persons also need to bring relevant certificates and reimbursement materials, such as ID cards, medical insurance cards, hospital invoices, expense lists, etc. And go to the local social security department or medical insurance agency for further review and reimbursement. The social security department or the medical insurance agency shall review the reimbursement application of the insured person and give the corresponding reimbursement amount according to the policy.

Third, matters needing attention

When applying for medical insurance reimbursement, the insured should pay attention to the following points:

1. Make sure that you have participated in medical insurance and paid the insurance premium on time.

2. Keep all invoices and documents of medical expenses, so as to provide complete supporting materials when applying for reimbursement.

3. Understand the local medical insurance policies and reimbursement standards to ensure that your reimbursement application meets the policy requirements.

4. If you have questions or encounter difficulties, you can consult the hospital, social security department or medical insurance agency for help in time.

To sum up:

Accidental hospitalization medical insurance can be reimbursed, but the insured needs to understand the medical insurance policy and reimbursement process, properly keep relevant supporting materials, and apply according to the policy. At the same time, in the process of reimbursement, we also need to pay attention to some matters that need attention to ensure that our rights and interests are protected.

Legal basis:

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

Article 28 provides that:

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

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

Article 30 provides that:

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.