Accident insurance reimbursement process of Tianjin employees' medical insurance

We all know that medical insurance is a matter of great concern to the country, and medical-related issues will be mentioned at the annual meeting. China implements different policies for different groups of people, and medical insurance for urban workers is one of them. I. Medical insurance reimbursement process for urban workers 1. The insured person in the city's tertiary hospitals (or specialized hospitals) sick, it is difficult to diagnose or no treatment, can apply for hospitalization in different places. 2, transfer must fill in the application form, signed by the designated hospitals above the third level in our city, and reported to the municipal medical insurance agency for examination and filing before being transferred to hospital for treatment. 3, the insured sudden illness in different places really need to be hospitalized in the local designated medical institutions, within 3 days after admission to the municipal medical insurance center for the record. 4, transfer and off-site emergency medical expenses paid by individuals, within one month after discharge to the city medical insurance center for reimbursement. Reimbursement materials: transfer approval form; Detailed list of hospitalization expenses; Invoice documents; Discharge summary and save relevant documents and materials. Two, the proportion of urban workers' medical insurance reimbursement reimbursement standards related to the level of the insured hospital. If you live in a tertiary hospital, the employee will pay 15%, that is, 85% for reimbursement, from the Qifubiaozhun to 30,000 yuan. The expenses of 30,000-40,000 yuan shall be paid by employees themselves 10%, and 90% shall be reimbursed; If the expenses exceed 40,000 yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%. Retirees pay 60% of the on-the-job employees, but all below the minimum threshold are paid by individuals. Three. Prerequisites for reimbursement of medical insurance for urban workers 1. The applicant has gone through the insurance formalities and paid the medical insurance premium in full. 2, the insured medical expenses incurred in medical institutions, pay cash in advance, and save the relevant documents and materials. 3. Going to the designated medical institutions of cooperative medical care: the general outpatient and emergency expenses incurred by the insured in the designated medical insurance hospitals or specialized hospitals, Chinese medicine hospitals and 3A hospitals selected by individuals. 4. Prepare the original invoice: personal cash pays for general outpatient and emergency expenses, resulting in medical expenses within the three categories of medical insurance. 5. Bring the medical insurance card and my ID card: 65438+ 0-20th of each month. The expenses of the current month shall be declared in the following month, and the expenses of the current year shall be applied for reimbursement before 1-20 of the following year. 6. The insured person submits the documents to the unit or social security office, and the unit or social security office enters the documents into the enterprise version, and then declares the electronic information and documents to the medical insurance center. The process of medical insurance reimbursement for urban workers is probably like this: you need to go to the local medical insurance management center or the medical insurance checkout window of designated medical institutions for reimbursement. The proof of formalities includes: my ID card, medical insurance card, original invoice, drug list, medical record book, list, admission/discharge certificate and other materials. The above is the relevant content of the medical insurance reimbursement process for urban workers, and I hope it will help everyone.