Employee medical insurance off-site how to use

There are certain processes and regulations that need to be followed, including the filing of the application for medical treatment in a different place, the settlement of medical expenses and the enjoyment of medical insurance benefits.

One, the foreign medical record

Employees in the foreign medical treatment, usually need to be in advance in the insured place of the health insurance agency for the record of foreign medical procedures. When filing, it is necessary to provide a valid identification, social security card and relevant documents to prove medical treatment. Through the record, employees can ensure that they can enjoy the health insurance treatment when they visit the medical institutions in other places.

Second: Settlement of Medical Expenses

When seeking medical treatment in a different place, the employee needs to choose a medical institution that complies with the regulations, and keep the relevant medical expense bills and consultation records. At the end of the visit, the employee can transfer the medical expenses in real time through the direct settlement system for medical treatment in a different place to the medical insurance agency in the place of participation for settlement. For cases where direct settlement is not possible, the employee can pay the medical expenses in advance and then bring the relevant materials back to the place of insurance for reimbursement.

Third, the enjoyment of medical insurance treatment

When employees seek medical treatment in a different place, they can enjoy the same medical insurance treatment as that in the place of participation, including hospitalization reimbursement, outpatient coordination, and reimbursement for special diseases, etc. However, it should be noted that different regions have different medical insurance treatment plans. However, it should be noted that there may be differences in the health insurance policies of different regions, so it is best for employees to understand the local health insurance policies before seeking medical treatment to avoid any misunderstanding or omission.

In addition, in order to ensure the smooth use of the employees' health insurance, it is recommended that the employees consult with the health insurance agency of the insured place in advance to understand the specific filing process, settlement method and treatment enjoyment before seeking medical treatment. At the same time, employees should also keep the relevant bills and records in the process of medical treatment for subsequent reimbursement or query use.

In summary:

The use of employee health insurance in a different place needs to follow certain processes and regulations, including the filing of the record of medical treatment in a different place, the settlement of medical expenses and the enjoyment of health insurance benefits. In order to ensure the smooth use of health insurance, employees need to understand the local health insurance policy in advance, and keep the relevant bills and records in the process of medical treatment. At the same time, the health insurance agency in the place of participation should also provide convenient services and support for foreign medical treatment, so as to facilitate the employees to enjoy their due health insurance treatment when they visit foreign medical institutions.

Legal basis:

The Social Insurance Law of the People's Republic of China

Article 29 stipulates that:

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly by the social insurance administration agencies and the medical institutions and drug business units. The administrative departments of social insurance and health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.

Article 30 stipulates:

The following medical expenses shall not be included in the scope of payment by the basic medical insurance fund:

(1) those that should be paid out of the Workers' Compensation Insurance Fund;

(2) those that should be borne by a third person;

(3) those that should be borne by the public ****health;

(4) those that seek medical treatment outside of China.

Medical expenses shall be borne by a third person in accordance with the law, and if the third person fails to pay or if the third person cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the first payment.