Hospital social security reimbursement process

Hospital social security reimbursement process is as follows:

1, patients with medical insurance card or ID card, household registration book and other valid documents to the hospital for medical insurance networking procedures;

2. Go directly to the hospital for settlement when you leave the hospital;

3. Or bring relevant materials to the relevant departments of the local social security center to apply for reimbursement.

4, outpatient social security reimbursement, individual pays part by patients with medical insurance card or cash payment, the rest by medical insurance and hospital direct settlement.

Conditions for reimbursement of hospital social security:

1. Qualification certificate of the insured: it must be a person who has participated in social insurance locally and has a normal insurance relationship;

2. The scope of reimbursement for medical expenses: it usually includes outpatient expenses, hospitalization expenses and drug expenses. , but must comply with the social security policy;

3. Choice of hospital for medical treatment: You must seek medical treatment in a designated social security hospital, and expenses incurred in non-designated hospitals shall not be reimbursed;

4. Preparation of reimbursement materials: including ID card, social security card, medical expense list, diagnosis certificate and other relevant documents;

5. Reimbursement ratio and limit: According to social security policies in different regions, the reimbursement ratio and annual reimbursement limit will be different.

To sum up, the hospital social security reimbursement process includes medical insurance networking procedures, settlement procedures in the hospital or bringing materials to the social security center to apply for reimbursement. Outpatient reimbursement, the individual pays part shall be borne by the patient, and the rest shall be settled by medical insurance and hospital.

Legal basis:

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

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.