The latest policy of medical insurance reimbursement in different places in Shanxi Province

The latest policies for reimbursement of medical insurance in different places in Shanxi Province are as follows:

1, Shanxi canceled the filing system for medical treatment in different places. Expanded the scope of designated medical institutions that provide off-site services. The designated medical institutions in the cities under the jurisdiction of Shanxi Province with the demand for settlement of medical treatment in different places will be included in the direct settlement of medical treatment in different places. In other words, the record is no longer needed for the designated medical institutions in which the insured person seeks medical treatment in different places;

2. Gradually promote the application of electronic medical insurance vouchers in different places. In order to facilitate the insured to pay for medical expenses, Shanxi Province has optimized the payment method, and changed the original settlement with medical insurance card to medical insurance code. In other words, the insured can complete the settlement in different places as long as they use the electronic medical insurance certificate.

Medical insurance reimbursement process in different places:

1, medical expenses of medical insurance personal account are reimbursed by medical insurance in different places. You can go to the medical insurance bureau regularly to handle the fund transfer procedures and transfer the medical insurance fund in the social security card account to your own bank account. Under normal circumstances, outpatient medical expenses are paid by individuals;

2. If you are hospitalized, the reimbursement of medical insurance in different places needs to be reported to the Medical Insurance Bureau for the record. When I leave the hospital, I will go to the medical insurance bureau to settle the hospitalization expenses with the hospital's diagnosis certificate, discharge summary, medication list, medical expense receipt and medical guarantee. If I can't come, I can also entrust an agent to handle it.

3. Provincial hospitals should be designated hospitals for local medical insurance;

4. The reimbursement rate is 88% for the threshold fee of more than 3,000 yuan, 90% for 3,000-5,000 yuan, 92% for 5,000-10000 yuan, and 95% for the maximum payment limit of more than10000 yuan, including 80% for Class B drugs and 70% for precious drugs, and special inspection. Medical expenses of individual medical insurance accounts can be transferred to the medical insurance bureau regularly, and hospitals in other provinces should be designated hospitals for local medical insurance.

Materials required for reimbursement of medical insurance in different places:

1, IC card, basic medical insurance card (green photo) or basic medical handbook for urban residents;

2. A valid receipt document (invoice);

3, hospitalization expenses summary list, medical insurance referral letter of introduction, discharge certificate;

4. Hospitalization materials: the first page of hospitalization medical records, admission records, operation records, discharge summary, large-scale inspection reports, long-term doctor's orders, and copies of temporary doctor's orders (sealed by medical institutions).

To sum up, for the insured workers in Shanxi Province, it is no longer necessary to go to the general outpatient clinics of designated medical institutions in other medical insurance co-ordination areas other than the insured places, or to buy medicines at pharmacies, and they can directly use the money in their personal medical insurance accounts for settlement.

Legal basis:

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and 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.