Employee medical insurance hospitalization reimbursement process

Employee medical insurance hospitalization reimbursement process generally includes the following steps:

1. Hospital registration

When employees need hospitalization, they need to register in the inpatient department of the hospital and submit relevant certificates and medical insurance cards. The hospital will issue hospitalization vouchers and hospitalization expenses pre-settlement sheets to employees.

2. Hospitalization

During hospitalization, employees need to receive treatment according to the doctor's requirements, and keep all medical certificates and charge lists.

3. Discharge settlement

After the expiration of hospitalization, employees need to go to the hospital's discharge settlement window for settlement. The hospital will settle the expenses according to the employee's medical insurance policy, and issue a list of expenses and reimbursement vouchers.

4. Application for reimbursement

Employees need to submit expense lists, reimbursement vouchers, hospitalization vouchers and other related materials to their social security agencies for reimbursement. Social security agencies to review the materials, meet the conditions to be reimbursed.

5. Reimbursement and distribution

After the social security agency has passed the examination, the reimbursement will be credited to the employee's bank account.

It should be noted that different regions and medical insurance policies may be different. It is best for employees to know the local specific medical insurance policy and reimbursement process before hospitalization reimbursement.

Legal basis:

Article 35 of the Regulations on Employees' Basic Medical Insurance shall be settled in accordance with the following provisions within a settlement year: (1) The minimum payment for hospitalization shall be borne by the individual, and the minimum payment shall be calculated according to the standard of the highest level medical institution, specifically: 800 yuan, a tertiary medical institution (hereinafter referred to as tertiary medical institution), and other medical institutions (including secondary medical institutions and corresponding medical institutions, the same below). (two) the maximum amount of hospitalization expenses paid by the employee medical insurance fund (based on the date of discharge, hereinafter referred to as the maximum hospitalization limit) is 360 thousand yuan. (3) The hospitalization medical expenses above the hospitalization Qifubiaozhun and below the maximum hospitalization amount shall be shared by the employee medical insurance pooling fund and individuals. The employee medical insurance fund is settled according to the excess progressive system, and the specific ratio is: 1. The minimum deductible for hospitalization is more than 40,000 yuan (inclusive), and the medical expenses incurred in tertiary medical institutions account for 82% of employees and 86% of retirees; Employees account for 84% and retirees account for 88% of medical expenses incurred in other medical institutions; The medical expenses incurred by community health service institutions account for 88% of the employees and 92% of the retirees. 24,000 yuan to 360,000 yuan (inclusive), medical expenses incurred by tertiary medical institutions, 88% of employees and 92% of retirees; Medical expenses incurred in other medical institutions account for 90% of employees and 94% of retirees; The medical expenses incurred by community health service institutions account for 92% of the employees and 96% of the retirees. (four) medical expenses above the maximum amount of hospitalization in accordance with the provisions of the serious illness insurance shall be borne jointly by the individual and the serious illness insurance fund.