How to reimburse medical insurance for serious illness?

The reimbursement methods of serious illness medical insurance are as follows:

1, send the medical certificate, basic medical insurance diagnosis and treatment manual and other materials to the medical insurance department of the hospital for registration and verification;

2, the use of social security cards or ID cards in designated medical institutions, designated retail pharmacies direct settlement;

3. After discharge or transfer, prepare medical records, diagnosis certificates, discharge records, invoices, expense lists and other materials;

4. Fill in the reimbursement application form and submit the reimbursement according to the template provided by the hospital or social security agency.

Serious illness medical insurance reimbursement process:

1, a patient who was treated in a designated medical institution and was diagnosed as a serious illness within the scope of medical insurance;

2. The patient goes through the hospitalization formalities in the hospital and uses the medical insurance card to settle the expenses;

3. The hospital uploads the patient's medical expenses information to the medical insurance system for review;

4. After approval, the medical insurance system will calculate the reimbursable expenses according to the policy;

5. After the patient pays the personal burden, the medical insurance fund pays the remaining reimbursement amount;

6. When the patient leaves the hospital, the hospital will issue a detailed list of expenses and reimbursement vouchers;

7. If there is any cost beyond the scope of medical insurance payment, the patient shall bear it.

To sum up, the reimbursement process of serious illness medical insurance includes submitting relevant medical materials for registration and verification, directly settling accounts at designated places with social security cards or ID cards, preparing complete medical records and expense proof materials, and filling out reimbursement application forms, aiming at simplifying procedures and improving the efficiency of patients' medical security.

Legal basis:

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

Article 28

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.