Employee medical insurance reimbursement process for serious illness

Ensure that employees can get timely financial assistance when facing major diseases.

First, prepare the reimbursement materials.

When employees need to reimburse medical expenses for serious illness, they need to prepare complete related reimbursement materials first. These materials usually include: medical expense invoices, diagnosis certificates, hospitalization records, medical insurance cards, etc. These materials are necessary to apply for reimbursement of serious illness, and employees should keep them properly during medical treatment.

Second, submit an application for reimbursement

After the employees prepare the reimbursement materials, they need to submit them to their units or social security agencies. When submitting the application, employees need to fill out the application form for reimbursement and attach all relevant materials. Fill in the application form accurately, so as not to affect the reimbursement progress.

Third, review the reimbursement application.

After receiving the employee's application for reimbursement, the social security agency will conduct a strict review. They will check the authenticity and completeness of the materials and whether they meet the reimbursement conditions. In the process of audit, if problems or questions are found, the social security agency will contact the employees in time to request to supplement or correct the relevant materials.

Four, accounting reimbursement amount

After approval, the social security agency will calculate the reimbursement amount according to the actual medical expenses and medical insurance policies of the employees. This amount will deduct the medical expenses compensation that employees have obtained through other channels to ensure that employees will not benefit from repeated reimbursement.

Verb (abbreviation for verb) payment of reimbursement

After the accounting is completed, the social security agency will pay the reimbursement to the employees. Payment can be made directly into the employee's bank account or in cash. After receiving the reimbursement, employees should carefully check whether the amount is correct and properly keep relevant vouchers.

To sum up:

The reimbursement process of employee's serious illness medical insurance includes the steps of preparing reimbursement materials, submitting reimbursement applications, reviewing reimbursement applications, accounting reimbursement amounts, and distributing reimbursement funds. In the whole process, employees need to ensure the authenticity and integrity of the materials and operate according to the prescribed procedures. The social security agency will strictly examine the application and calculate the reimbursement amount to ensure that employees can get the medical expenses compensation they deserve in time.

Legal basis:

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

Article 23 provides that:

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Article 28 provides that:

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.

Regulations of People's Republic of China (PRC) Municipality on Social Medical Insurance

Article 10 stipulates:

The medical expenses incurred by the insured in the designated medical institutions in accordance with the provisions shall be paid by the basic medical insurance fund in accordance with the provisions.