Ulaanbaatar Social Security Bureau, Medical Insurance Unit

Social health insurance reimbursement is reimbursed after discharge or transfer.

Settlement procedures for hospitalization and outpatient treatment of special diseases:

Specified medical institutions will report the cost settlement statement, hospitalization settlement statement and relevant information of patients discharged from hospitals in the previous month to the medical insurance agency before the 10th day of each month, which will be used as the basis for the monthly advance appropriation and year-end settlement after examination and approval by the medical insurance agency;

Medical insurance agencies will make monthly advance appropriations of hospitalization and outpatient treatment costs for the previous month;

Medical insurance agencies will make monthly advance appropriations of hospitalization and outpatient treatment costs for the previous month.

Participants who are recognized as suffering from special diseases should go to one of the designated medical institutions designated by the labor security department for medical treatment and purchase of medicines, and the medical expenses incurred will be recorded directly in the accounts and settled instantly.

Emergency Settlement Procedures: If a participant is hospitalized in a non-designated medical institution in the city or in a medical institution in a different place due to an emergency, the medical expenses incurred shall be paid by the individual or the unit in advance, and after the emergency is over, the participant shall go through the reimbursement procedures with the hospital's emergency medical record, examination and laboratory report form, invoice, and a detailed list of medical charges, etc., in accordance with the provisions of the medical insurance agency.

Settlement procedures for staff resettled in other places:

The staff resettled in other places shall be assigned 1-2 designated medical institutions in their place of residence by their units and report to the medical insurance agency for the record;

Medical expenses incurred by the staff resettled in other places who are sick in designated medical institutions in their place of residence shall be advanced by themselves or by their units, and the medical expenses incurred by the staff resettled in other places shall be paid by themselves or by their units in advance and shall be paid by their units with a certificate of medical fees and charges of the insured person at the hospitals.

The medical expenses incurred by a staff member residing in a foreign country who is ill at a designated medical institution shall be paid in advance by the staff member or his/her unit, and after the treatment is completed, the medical expenses shall be settled by his/her unit with the staff member's medical certificate and medical records, valid expense bills, duplicate prescriptions, and list of hospitalization expenses, etc., on the specified date at the social medical insurance agency.

Referral and transfer settlement:

If the insured person is referred to other medical institutions for diagnosis and treatment due to the limitations of the designated medical institutions or due to specialized diseases, he/she has to fill in the approval form for referral and transfer. By the attending physician to put forward the reasons for referral and transfer, the department director to put forward the referral and transfer opinions, the medical insurance office of the medical institution audit, the signature of the dean in charge, reported to the Municipal Medical Insurance Center for approval before transfer;

The referral and transfer of hospitals, in principle, first in the city and then out of the city, the first in the province and then out of the province. Intra-city referrals and transfers are to be made between designated medical institutions. Out-of-town referrals and transfers must be made by a designated medical institution at or above the third level in the city;

Medical expenses incurred by a participant after a referral and transfer to a hospital shall be advanced in cash by the individual or the unit, and after the completion of medical treatment, the participant or his/her agent shall reimburse to the medical insurance agency for the hospitalization expenses that fall within the scope of payment by the integrated fund, with the approval form for the referral and transfer to the hospital, the medical record certificate, the prescriptions and the valid documents.

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