How to deal with medical insurance for serious diseases and chronic diseases?

The medical insurance process for serious illness and chronic diseases mainly includes understanding policies, preparing materials, selecting designated medical institutions, registering medical treatment, settling expenses, applying for reimbursement, reviewing reimbursement and receiving reimbursement funds.

The medical insurance process for serious illness and chronic disease is as follows:

1. Understand the policy: First of all, we must understand the medical insurance policy for severe and chronic diseases in our district, including the scope, proportion and limit of reimbursement. This information can be obtained by consulting social security bureau, hospitals or consulting relevant policy documents.

2. Preparation materials: according to the policy requirements, prepare relevant certification materials, such as ID card, household registration book, disease diagnosis certificate, medical expense invoice, etc. Ensure that all materials are true and effective and will not affect the medical insurance reimbursement.

3. Choose designated medical institutions: patients with serious illness or chronic diseases need to go to designated designated medical institutions to enjoy medical insurance reimbursement. Therefore, when choosing a hospital, we must ensure that the hospital is a designated medical insurance unit.

4. Medical registration: bring relevant certification materials to the designated medical institutions for medical registration. In the process of seeing a doctor, you should take the initiative to explain to the doctor that you are a patient with serious illness or chronic disease, so that the doctor can draw up the corresponding diagnosis and treatment plan and cost list.

5. Settlement expenses: After the visit, submit the medical expense invoice, diagnosis and treatment plan, expense list and other related materials to the financial department of the hospital for expense settlement. When you check out the account, you should pay attention to checking the expense details to ensure that it is correct.

6. Reimbursement application: submit the settled expense invoice, diagnosis and treatment plan, expense list and other related materials to the local social security bureau or medical insurance center to apply for medical insurance reimbursement. When applying for reimbursement, you should fill in the application form according to the policy requirements and attach relevant supporting materials.

7. Review reimbursement: The Social Security Bureau or the medical insurance center will review the submitted reimbursement materials, and after the review is passed, the reimbursement will be transferred to the patient's medical insurance account. If the audit fails, it is necessary to supplement or modify relevant materials according to the audit opinions and resubmit the reimbursement application.

8. Receiving reimbursement: Patients can check the balance of medical insurance account to find out whether the reimbursement has arrived. If the reimbursement has arrived, you can withdraw it from the bank or social security bureau or transfer it to your personal bank account.

In this process, patients need to pay attention to the following points:

1. Know the policy in advance: The medical insurance policy for serious illness and chronic disease varies from region to region, and patients need to know the policy requirements in their region in advance in order to apply for medical insurance reimbursement according to regulations.

2. Prepare authentic and effective materials: when handling medical insurance reimbursement, you need to provide relevant supporting materials. Patients should ensure that the materials provided are true and effective, so as not to affect the medical insurance reimbursement.

3. Choose designated medical institutions: patients with serious illness or chronic diseases need to go to designated designated medical institutions to enjoy medical insurance reimbursement. Therefore, when choosing a hospital, we must ensure that the hospital is a designated medical insurance unit.

4. Inform the doctor of his own identity: During the process of seeing a doctor, the patient should take the initiative to explain to the doctor that he is a patient with serious illness or chronic disease, so that the doctor can draw up the corresponding diagnosis and treatment plan and cost list.

5. Pay attention to expense settlement: After the visit, the medical expense invoice, diagnosis and treatment plan, expense list and other related materials should be submitted to the financial department of the hospital for expense settlement. When you check out the account, you should pay attention to checking the expense details to ensure that it is correct.

To sum up, the process of medical insurance for serious illness and chronic diseases includes understanding policies, preparing materials, selecting designated medical institutions, registering for medical treatment, settling expenses, applying for reimbursement, reviewing reimbursement and receiving reimbursement funds. Patients should pay attention to know the policy in advance, prepare real and effective materials, choose designated medical institutions, actively inform doctors of their identity, and pay attention to the settlement of expenses to ensure the smooth progress of medical insurance reimbursement.

Legal basis:

Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers

Article 19

All the basic medical insurance premiums paid by employees are included in personal accounts.

25-35% of the basic medical insurance premium paid by the employer is used to establish individual accounts for retirees and employees, and the specific payment methods are formulated by the provincial people's government according to the principle of caring for the elderly; The remaining funds are used to establish a unified fund.

Article 20

The basic medical insurance fund shall be managed by two lines of revenue and expenditure, and shall be included in the financial special account of the social insurance fund, which shall be earmarked for the basic medical care of employees and retirees and shall not be used for other purposes.