How to reimburse medical insurance?

Medical insurance reimbursement process:

1. The agent submits the reimbursement documents and other materials to the social security agency for acceptance;

2. After receiving the application materials, the accepting department shall review, settle accounts and pay;

3. If the social security agency approves the application, the applicant will be reimbursed after receiving the "Social Medical Insurance Medical Expense Reimbursement Form".

legal ground

Article 26 of People's Republic of China (PRC) Social Insurance Law

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28 of People's Republic of China (PRC) Social Insurance Law

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

Medical insurance reimbursement, drug purchase, outpatient service, hospitalization, different medical insurance reimbursement regulations.

1. When purchasing medicine, the cardholder will go to the designated medical insurance institution to purchase medicine, and the expenses will be paid by the personal account;

Medical insurance is divided into two accounts, personal account and medical insurance card. The money can be used to buy medicine at designated pharmacies, pay outpatient expenses and pay the part of hospitalization expenses that the individual pays. The overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement are paid by the overall account.

2. Go to the outpatient clinic and keep the original diagnosis certificate, medical records, report forms and expense receipts. And go to the local social security agency for reimbursement;

When seeking medical treatment, show the medical insurance card to the designated hospital to prove the identity of the insured. At the time of checkout, the part paid by the individual is paid by medical insurance card or cash, and the part reimbursed by medical insurance is settled by medical insurance and hospital, and the individual does not need to pay first and then reimburse;

3, when in hospital, save a certain amount of money first, when discharged from hospital, pay and settle according to the proportion of medical insurance reimbursement, refund more and make up less.

There is a deductible for hospitalization reimbursement, which means that you need to pay the deductible, and the part that exceeds the deductible can be reimbursed according to local medical insurance regulations. The reimbursement rate varies from place to place, about 75%.