Sporadic reimbursement process of Nanjing medical insurance

Nanjing medical insurance reimbursement process 1. Insurance registration: the unit receives the social insurance registration form and medical insurance declaration software, and provides relevant documents and materials as required. 2. Fund raising: The insured unit shall pay the medical insurance premium to the medical insurance agency every month or before the first month of each quarter 10. If the payer fails to pay the medical insurance premium according to the regulations, an overdue fine of 2 ‰ will be added daily from the date of default, and the overdue fine will be incorporated into the medical insurance fund. The salary base is determined according to the average monthly salary of employees in the previous year and adjusted at the beginning of each year. 3. Outpatient medical treatment and IC card use: employees of the unit need to apply for IC cards after participating in the insurance. When you are sick, you need to take a double prescription book and IC card to the designated medical units and designated retail pharmacies for medical treatment and medicine purchase; IC cards need to be deposited before use, and cardholders can deposit personal account funds in the self-service deposit machine of China Agricultural Bank or designated medical units every month or quarter; When using, the insured person swipes the card at the POS machine of the designated unit with the prescription and IC card, and the medical expenses are deducted from the personal account funds; If the IC card is lost, the cardholder can report the loss to the business outlets of Agricultural Bank of China with valid identity documents and reissue the IC card at the same time. 4. Hospitalized patient management and expense settlement: (1) When the insured is hospitalized, he/she must provide relevant information such as hospitalization approval form, outpatient medical record, ID card, double prescription book, copy of home page (with one page of photos attached) and go through the examination and approval formalities at the medical insurance agency in advance; (2) In networked hospitals, employees pay the hospitalization deposit first, and the expenses are settled by microcomputer when they leave the hospital, and employees only pay the medical expenses that individuals should bear; In hospitals that are not connected to the Internet, the hospitalization medical expenses shall be fully settled by individual employees, and reimbursed by the unit to the medical insurance agency at the end of each quarter. 5. Handling referral and expense settlement: When the insured person really needs to go to the medical insurance agency for treatment due to illness, he must go through the examination and approval procedures in advance. At the time of examination and approval, it is necessary to hold a diagnosis certificate signed by a full-time doctor of a designated medical unit, a referral approval form, a medical record, an ID card, a double prescription book and a copy of the first page of the prescription book. The medical expenses incurred shall be paid in cash first, and the unit shall reimburse the medical insurance agency at the end of each quarter. 6. Emergency patients can be rescued in public medical units nearby, but they must go through the formalities at the medical insurance agency within 2 days, and the holidays will be postponed. 7, resettlement personnel should choose a public hospital as a designated hospital in the place of residence, and report to the medical insurance agency for approval and filing. The medical expenses incurred shall be paid by the individual first, and the unit shall summarize them to the medical insurance agency for reimbursement quarterly.

Legal objectivity:

"People's Republic of China (PRC) Social Insurance Law" Article 29 The part of the medical expenses of the insured that should be paid by the basic medical insurance fund 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.