Medical insurance reimbursement process

Legal analysis: reimbursement process of serious illness medical insurance

1. Materials required for reimbursement of serious illness medical insurance

1) ID card of the insured;

2) medical insurance or medical insurance card of the insured;

3) Original and photocopy of medical expense settlement list.

2. Serious illness medical insurance reimbursement process

1) The insured shall bring the above materials to the medical insurance department of the local designated hospital to fill in the relevant forms for preliminary examination;

2) Designated hospitals will report the information of insured residents who have passed the preliminary examination to the urban medical insurance agency for review;

3) The insured residents who pass the final examination shall be reimbursed by the urban medical insurance agency for serious illness medical insurance.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

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.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.

Thirty-first social insurance agencies may, according to the needs of management services, sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior.

Medical institutions shall provide reasonable and necessary medical services for the insured.