How to reimburse children's medical insurance?

The reimbursement process of children's medical insurance is as follows:

1, confirm the medical insurance qualification: First, confirm whether the children meet the medical insurance qualification, that is, whether they have participated in the basic medical insurance for urban and rural residents or employee medical insurance;

2. Medical expenses settlement: after seeing a doctor, you need to go to the cashier window of the medical institution to settle the medical expenses and pay the self-funded part (if any);

3. Invoices and vouchers: Medical institutions will issue invoices and vouchers, including outpatient medical records, expense lists, medical insurance fund payment vouchers, etc.

4. Submit reimbursement materials: reimbursement materials include medical insurance cards, medical expense invoices, expense lists, outpatient medical records, payment vouchers of medical insurance funds, etc. Submit reimbursement materials to the local social security bureau or medical insurance center within the specified time;

5. Review the reimbursement materials: the Social Security Bureau or the medical insurance center will review the reimbursement materials to confirm whether the expense items and amounts meet the medical insurance regulations;

6. Reimbursement: After the approval, the medical insurance center will pay the medical insurance fund to the medical institution, and at the same time return the part paid by the individual to the personal account or distribute cash on the spot.

Benefits of children's medical insurance:

Increased the treatment of general outpatient service. The fund payment capping line has been greatly improved. If the insured person has participated in local supplementary medical insurance for 6 years, there is no capping line for fund payment. The hospitalization deductible has been lowered for 200 yuan. The accounting proportion of hospitalization medical expenses is increased from 80% to 90% to 90% by stages. The types of diseases in serious illness clinics have expanded. Because inpatient medical insurance has also participated in local supplementary medical insurance, the diagnosis and treatment items, drug list and outpatient diseases of serious and serious diseases have all been expanded and increased.

To sum up, after children's medical insurance is merged into inpatient medical insurance, its treatment and management will be implemented in full accordance with the provisions of inpatient medical insurance, which will greatly improve the medical insurance benefits of insured children and college students, and at the same time facilitate the medical treatment methods of insured children and college students.

Legal basis:

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

Article 28

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.