How to reimburse employee medical insurance in critical illness insurance?

The reimbursement methods of employee medical insurance critical illness insurance are as follows:

1. When the employee's serious illness insurance is reimbursed, the insured must take the medical insurance card to the designated medical institution or retail pharmacy to settle the expenses;

After discharge or transfer, they can be reimbursed by medical insurance card;

2 reimbursement expenses shall conform to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, as well as emergency and rescue medical expenses, and shall be paid from the basic medical insurance fund in accordance with state regulations;

3. If the expenses for diagnosis and treatment of major diseases are within the scope of drug list and diagnosis and treatment items, you can bring social security cards and other materials to social insurance agencies and medical institutions for reimbursement;

Not satisfied, need to bear;

4. When reimbursing medical insurance for workers' outpatient service, you need to bring medical records, insurance vouchers, expense lists and other materials, and settle them directly when you leave the hospital.

The hospital and the individual settle their own expenses and their own expenses, and the reimbursement amount of the overall fund is settled by the hospital and the district medical insurance center.

Employee medical insurance reimbursement process:

1. The patient went to a designated medical institution and was diagnosed as a major disease;

2. The patient goes through the hospitalization formalities in the hospital and shows his medical insurance card and ID card;

3. The hospital settled the expenses according to the patient's medical insurance policy, and the patient paid part of the expenses;

4. When leaving the hospital, the hospital will directly deduct the corresponding expenses from the medical insurance account according to the medical insurance regulations, and the patient will pay the personal part;

5. For expenses beyond the scope of medical insurance payment, patients can apply to social security institutions for Medicaid for major diseases;

6, social security agencies to review the application submitted by patients and related documents, determine the amount of subsidies and apply for reimbursement.

To sum up, the reimbursement method of employee medical insurance in critical illness insurance is to settle the expenses in designated medical institutions or retail pharmacies. The expenses that meet the prescribed scope shall be paid by the basic medical insurance fund, and the expenses that do not meet the requirements shall be borne by themselves. Outpatient medical insurance reimbursement shall be settled directly with relevant materials.

Legal basis:

People's Republic of China (PRC) social insurance law

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.