Manual reimbursement of medical insurance process

First, the applicant needs to go through the reimbursement application procedures, and then submit the relevant application materials required for reimbursement. The place where the materials are submitted is the Medical Insurance Section of the Social Security Branch of the Social Security Fund Administration requested by the insured. After receiving the applicant's application for reimbursement, the acceptance department of the General Administration will review the application materials provided by the applicant within 5 days from the date of receiving the materials, and decide the final acceptance result.

Manual reimbursement process of medical insurance

The manual reimbursement process of medical insurance requires social security personnel to scan, enter, upload and print the details one by one after receiving all the bills. After the seal of the unit is prepared, it shall be reported to the medical insurance center for review. All the required materials are indispensable, otherwise they will not be reimbursed. If the bill is lost, it needs to be reissued in the hospital.

Declare hospitalization expenses

1, social security card;

2. Charge bills;

3. Detailed list of hospitalization;

4, Beijing medical insurance referral (hospitalization) list;

5. Diagnosis certificate and/or discharge certificate;

6. Full settlement certificate issued by the hospital.

If the medical expenses are paid in full by the individual in cash and meet the payment conditions of the medical insurance fund, the outpatient medical expenses will be reimbursed manually according to the situation.

(1) failed to issue a card after registration;

(2) The insured fails to hold the card in case of emergency;

(3) unit arrears;

(4) Seek medical treatment during the period of manual reimbursement;

(5) seeking medical treatment during the replacement of social security cards;

(6) seeking medical treatment in different places;

(7) family planning surgery.

legal ground

Social insurance law

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.