Shanghai young children hospitalization medical insurance reimbursement process

Shanghai toddler hospitalization medical insurance reimbursement process is as follows:

1, admission or discharge must hold medical insurance IC card to the designated medical institutions medical insurance management window for hospital registration procedures;

Hospitalization should be paid in advance by an individual 2000 yuan of medical fees, and more or less to make up for the discharge checkout. Medical fees incurred before the hospitalization registration procedures shall not be included in the basic medical insurance payment scope. If you are hospitalized due to an emergency and fail to apply for hospitalization registration procedures in time, you should go to the medical insurance management window on the next day after admission (postponed on holidays) with the certificate of emergency to make up for the hospitalization procedures, and you will be responsible for your own medical fees if the time limit is exceeded;

2. The starting line of the integrated fund for the hospitalization of the insured persons is divided into three grades:

1,000 yuan for a tertiary hospital, 600 yuan for a secondary hospital, and 400 yuan for a first-class hospital. In a basic medical insurance settlement year, the medical fees for multiple hospitalizations are calculated cumulatively;

3. If an insured person needs to be referred to a hospital due to his condition, he must be diagnosed by the deputy chief physician or the head of the department of the designated medical institution (above the third level) and put forward the opinion of referral, and his unit will fill out an application form, and then submit it to the social security institution of the city (district) for approval after the examination and approval of the medical insurance management department of the designated medical institution. For the referral (hospital) procedures;

The referral is limited to the provincial special hospital, the cost of which is first paid by the person, and the reimbursement standard should be 10% out-of-pocket, and then calculate the amount of reimbursement in accordance with local regulations;

4. When discharged from a designated medical institution, the designated medical institution will calculate the amount of reimbursement and the amount that should be out-of-pocket for the individual in accordance with the relevant policies, and the reimbursement amount will be settled by the designated medical institution and the municipal social insurance agency. The reimbursement amount will be settled between the designated medical institution and the city social insurance agency, and the amount that the individual should pay out of pocket will be settled between the designated medical institution and the insured person himself.

Hospitalization medical insurance includes:

China Merchants Bank OneNet Insurance reminds that hospitalization medical insurance is divided into reimbursement type and subsidized type. Reimbursement-type medical insurance generally refers to the insurance product that the insurance company reimburses the insured person for the costs of bed, medicine, treatment, nursing care, examination and testing, special examination and treatment, ambulance fees and other expenses after the insured person is hospitalized. Consumers are required to provide invoices and other relevant documents to the insurance company for reimbursement.

In summary, the subsidized type does not require invoices for reimbursement, and the insurance company will subsidize the purchased amount according to the number of days of hospitalization under the relevant regulations, and some insurance companies call this type of product a hospital income protection insurance. Some insurance companies call these products hospitalization income protection insurance. Critical illness insurance on the market also belongs to the subsidized type, which pays out according to the insured amount without invoices.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and treatment items, standards of medical services and facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.

Article 29

The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.

The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.