Detailed steps of employee medical insurance reimbursement process

The detailed steps of employee medical insurance reimbursement process are as follows:

1, patients hospitalized in designated medical institutions in the region need to show their medical insurance cards and pay a certain threshold fee; Go to the hospital medical insurance settlement office for reimbursement after discharge;

2. When the inpatients in different places are reimbursed, they need to carry the hospitalization settlement invoice, the detailed list of expenses, the discharge record, the copy of the voluntary book of drugs and special diagnosis and treatment items outside the catalogue, and handle the reimbursement with relevant credentials and ID cards after 5 working days;

3. If you are hospitalized in a different place due to emergency, you should communicate with the social security hotline of the insured place first, and then apply for medical insurance in different places after obtaining the consent;

4. When reimbursing, you need to seek medical treatment in the designated medical institutions of basic medical insurance, and bring your ID card or social security card, disease diagnosis certificate, outpatient medical records, inspection reports and other materials to the local social security center.

Employee medical insurance reimbursement scope:

1. Outpatient expenses: including medical expenses of employees in general outpatient service, specialist outpatient service and chronic disease outpatient service in designated medical institutions;

2. Hospitalization expenses: refers to the medical expenses incurred by employees during hospitalization in designated medical institutions;

3. Drug expenses: including the drug expenses in the medical insurance catalogue, and some drugs that are not in the medical insurance catalogue may not be reimbursed;

4. Special treatment expenses: the expenses of special treatment items such as dialysis, radiotherapy and chemotherapy;

5. Expenses for assistive devices: such as artificial limbs, orthotics and other assistive devices specified by medical insurance;

6. Medical examination expenses: Medical insurance for employees in some areas may include reimbursement of regular medical examination expenses.

The above contents cover the main scope of medical insurance reimbursement for employees, but the specific reimbursement ratio and limit may be different due to different regional policies. When employees enjoy medical insurance reimbursement, they must first understand the local medical insurance policies and reimbursement rules.

To sum up, the medical insurance reimbursement process for employees includes showing insurance cards, paying threshold fees, bringing relevant materials for reimbursement when hospitalized in designated medical institutions inside and outside the region, communicating with the social security hotline for emergency hospitalization in different places and filing. Finally, provide complete medical information to the social security center, and complete the reimbursement procedures when hospitalized in the designated medical institutions of basic medical insurance. The whole process requires the patient to prepare a complete file and proceed according to the specified time node.

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.