How to apply for sporadic reimbursement of medical expenses in Shanghai medical insurance for off-site medical treatment

I. Conditions of application

Shanghai's active employees, retirees, and urban and rural residents participating in the city's basic medical insurance are eligible to apply for reimbursement of basic medical expenses settlement.

Emergency reimbursement

According to the relevant regulations, Shanghai health insurance participants can apply for basic medical expenses reimbursement, including the scope of the medical expenses incurred in the emergency at the designated medical institutions of health insurance in foreign provinces and cities. Participants provide information, including valid identification documents, medical insurance card or social security card and my bank debit card, emergency medical fees special receipt, etc., to the town community affairs acceptance center, the district health insurance center to apply for reimbursement; can also be through the "one network through the" platform "medical fee reimbursement of one thing

Outpatient Reimbursement

For outpatient medical treatment in foreign provinces and cities, you can use the new version of social security card to make outpatient direct settlement at designated hospitals that have opened direct settlement for outpatient medical treatment in other places, or you can make odd reimbursements afterwards after full cash settlement. In addition, in the Yangtze River Delta Demonstration Zone, free of record, participants can hold the new version of the social security card in the designated hospitals that have opened the outpatient direct settlement of outpatient outpatient direct settlement.

The following information is required to apply for incidental reimbursement of basic medical expenses:

1. Valid identity documents of the insured.

2. The participant's health insurance card or social security card and his/her bank debit card.

3. Receipts for emergency medical expenses (with itemized lists) and copies of relevant medical history (e.g., examination, laboratory and imaging reports, Chinese medicine prescriptions, etc.).

4. Receipts for outpatient medical expenses (with itemized lists), "Notice of Damage to Medical Insurance Card", relevant medical history and copies (e.g., examination, laboratory and imaging reports, Chinese medicine prescriptions, etc.).

5. Emergency observation room hospitalization observation medical fee receipt, discharge (observation) summary, emergency observation room hospitalization observation medical fee list and copy, related medical history and copy.

6. Special receipt for inpatient medical expenses, list of inpatient medical expenses and copy, discharge summary and copy, relevant medical history and copy.

7. Other relevant documents that the health insurance staff requires the person concerned to supplement due to special circumstances.

8. If you entrust someone else to handle the case, you should also provide a valid ID document of the person who will handle the case.

Three, the process

1, emergency reimbursement

(1) window processing: if Shanghai participants in the case of emergency or emergency hospitalization of medical expenses incurred in foreign provinces and cities without the preparation or transfer of medical relations, you can bring the above required materials to the community affairs acceptance center of the streets and towns, the district health insurance center to apply for reimbursement;

(2) Online application: You can also apply for reimbursement online through the "One Net One Office" platform's "Medical Expense Reimbursement"

Processing Instructions

Shanghai's active employees, retirees, and urban and rural residents participating in the city's basic medical insurance can apply online for reimbursement of basic medical insurance expenses. You can apply for reimbursement of basic medical insurance expenses online, and after applying online, you need to send the original invoice and paper documents to the community acceptance center by logistics. The cost of sending the invoice and paper documents by logistics is borne by the applicant: 10 RMB/piece in Shanghai, 12 RMB/piece in Jiangsu and Zhejiang, 14 RMB/piece in Anhui, and 20 RMB/piece in other parts of China.

Application Steps

Step 1: Open the official website of "Shanghai One Net Office" and type "medical fee reimbursement" into the search box;

Website:

Step 2: Next, click on "Medical Fee Reimbursement" in the page that pops up. Click on "Medical Expense Reimbursement";

Step 3: After you have successfully registered and logged in, you will enter the declaration page, select "Basic Medical Expense Reimbursement", click Next to complete the information and upload the relevant materials according to the requirements to apply for reimbursement.

2, outpatient reimbursement

In the outpatient medical treatment in foreign provinces and cities, you can hold the new version of the social security card in the designated hospitals that have opened the outpatient direct settlement of outpatient direct settlement, or you can be reimbursed sporadically afterwards after the full cash settlement. In addition, in the Yangtze River Delta Demonstration Zone, free of record, participants can hold the new version of the social security card in the designated hospitals that have opened the outpatient direct settlement of outpatient outpatient direct settlement.

For more questions related to health insurance, you can call the health insurance consultation hotline 12393.