How to reimburse Shanghai medical insurance for medical treatment in different places

Shanghai medical insurance reimbursement process in different places;

1, medical treatment in different places needs to be approved by relevant departments first. The examination and approval place for resettlement in different places is the county medical insurance center where the insured unit or street social security is located. After applying for the relevant approval form, fill in the relevant contents. Take the relevant documents to the medical insurance department of a different hospital and stamp them. Then return the relevant approval form to the applicant for approval;

2. The time limit for examination and approval in different places is generally one year, that is, from the date of handling to the date of the second year. You can't change it within a year. If the approval period has passed, the parties who are still in different places need to go to the relevant departments for re-approval. For the parties in different places, it is essential to choose a different hospital. The regulations on how many hospitals patients can choose in different regions are different. Generally, you can choose two or three;

3. It is essential for people who seek medical treatment in different places to meet reimbursement in different places. Relevant personnel need to go to outpatient department and hospital to issue receipts, lists, prescriptions, details, medical insurance manuals and case diagnosis certificates. The more detailed, the better. At the same time, don't forget to issue the registration certificate of the hospital where you go to see a doctor, so that employers, social security offices and district and county medical insurance centers can make statistical summary and audit settlement;

4. For the medical expenses incurred by the parties in designated hospitals in different places, mail the relevant reimbursement documents back to the original city for reimbursement, or ask family members to help with reimbursement in the original city. Issues such as reimbursement standards will still be in accordance with the regulations of the city, and relevant funds can be collected by family members or related accounts can be set up.

Reimbursement standard of medical insurance for chronic diseases:

1. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class A shall be paid by the overall fund at 85%. The expenses of outpatient hemodialysis, peritoneal dialysis and cyclosporine A after organ transplantation in patients with chronic renal failure were further increased by 10 percentage point.

2. Qifubiaozhun for Class B chronic diseases: 300 yuan. Outpatient medical expenses that meet the requirements of patients with chronic diseases of Class B shall be paid 80% above the deductible standard, and shall not exceed the maximum payment limit for chronic diseases within one medical year or within the validity period;

3. The insured can identify two chronic diseases of Class B at the same time, and manage them according to the two diseases identified first, and calculate the deductible for each disease separately. The identification and management of chronic diseases and the maximum payment limit shall be adjusted by the human resources and social security department according to the overall fund income and expenditure. The standards, rules and procedures for the identification of chronic diseases shall be formulated separately by the municipal administrative department of human resources and social security.

To sum up, the insured can only seek medical treatment in designated medical institutions in different places after going through the confirmation procedures for medical treatment in different places. The amount of his personal medical account can be withdrawn through any business outlet of the medical insurance card, which is used to support the expenses of outpatient general diseases and the expenses of drug purchase and dispensing in pharmacies. The insured person's hospitalization, including outpatient treatment of specific items, can be carried out in local designated medical institutions, and the medical expenses will be paid in advance by individuals.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.