How to reimburse self-funded medical expenses?

The use method and scope of the medical insurance card are as follows:

(1) The medical insurance card can be used for further medical treatment. First of all, you must show your social security card when registering, and pay your own expenses and expenses in cash. The hospital will issue a bill for the insured; Secondly, when going to the clinic to see a doctor, you should take the initiative to show the doctor the social security card and the emergency medical record manual of the regional medical institution; Thirdly, the social security card and payment documents must be handed over to the settlement personnel to pay personal and self-funded expenses; Finally, after getting the settlement documents, carefully check the contents of the documents and recover the social security card. Insured persons who have received social security cards must show their social security cards when seeking medical treatment in designated medical institutions that have opened card-based medical settlement services. If the social security card is not presented, the expenses incurred shall be borne by the individual in full, and the medical insurance fund cannot pay it. If the insured person goes to the hospital for emergency treatment, family planning surgery, enterprise arrears, replacement of cards, failure to issue cards after enrollment, etc. The medical expenses incurred can be paid in cash by the individual first and then reimbursed by the medical insurance agency according to the original process.

(2) Medical insurance card reimbursement. After holding a card for medical treatment, the patient only bears the medical expenses that the individual should bear, and the expenses that should be reimbursed are directly settled by medical institutions and medical insurance departments. Cardholders encounter four special situations and need to pay medical expenses in full in cash before reimbursement: First, they don't bring social security cards in the emergency department; Second, family planning surgery; Third, enterprises owe medical insurance premiums; Fourth, during the replacement of social security cards.

Legal basis:

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

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.