How to reimburse children for outpatient service in different places at their own expense?

The self-funded reimbursement process for children's out-of-town clinics is as follows:

1. After children pay for medical treatment in different places, they should pay medical expenses in advance and keep relevant bills;

2. Bring bills, medical records, prescriptions and other valid documents to the medical insurance agency to apply for reimbursement;

3 referral, after the treatment, the referral approval form and the above documents to the medical insurance agency for reimbursement;

4. Reimbursement expenses must be within the scope of payment of the overall fund.

Scope and policy of social security reimbursement:

1. reimbursement ratio: the reimbursement ratio of outpatient service may be different in different regions and different social security types;

2. Reimbursement scope: It usually includes medicine fees, medical treatment fees, examination fees, etc. , but some self-funded drugs and high-end medical services may be excluded;

3. Reimbursement process: the reimbursement process generally includes the steps of submitting an application for reimbursement, carrying relevant bills and supporting materials, and reviewing;

4. Reimbursement in different places: Reimbursement in different places may require more supporting materials and the reimbursement process may be more complicated;

5. Reimbursement limit: the annual reimbursement limit set according to the social security policy, and the excess may need to be paid at your own expense.

To sum up, children's out-of-town clinics need to pay medical expenses and keep bills properly, and then bring valid documents such as bills, medical records and prescriptions to the medical insurance agency to apply for reimbursement. If there is a referral, it must be handled with relevant approval forms and documents after seeing a doctor, and the reimbursement expenses should be within the scope of the overall fund payment.

Legal basis:

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

Article 23

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Regulations on basic medical insurance for urban workers

Article 27

Employers who pay the basic medical insurance premiums in accordance with these regulations enjoy the basic medical insurance benefits.