Where does the medical insurance reimbursement go?

The money reimbursed by medical insurance is transferred to the insured's social security card, medical insurance card or designated bank account. If it is a medical insurance reimbursement in social security, that is, if you go to a hospital in a different place without filing with the local medical insurance department, you need to pay the medical expenses first, and then go back to the local medical insurance department for reimbursement with hospitalization information after discharge. If you are hospitalized in the medical insurance co-ordination area, it belongs to the medical insurance reimbursement part, and it is basically settled in the hospital in real time.

Medical insurance reimbursement scope:

1. Medical insurance card reimbursement is limited to medical expenses above hospitalization caused by diseases and some accidents in designated hospitals.

Reimbursement formula: (total cost-threshold cost-self-expense-cost overrun) *(75+ age *0.2)%. Generally speaking, the actual reimbursement rate ranges from 20% to 60%.

Self-funded drugs are not reimbursed, 80% of Class B drugs are reimbursed, bed fees are limited, and some inspection fees and treatment fees cannot be reimbursed according to regulations.

2. The reimbursement amount of medical insurance card is 4 times of the average salary of local social workers (1 year cumulative value).

3. The money in the medical insurance card can be used to buy medicines at designated pharmacies and pay for outpatient and emergency expenses, but it does not belong to the category of reimbursement, because the money in the medical insurance card is the money in the medical insurance personal account.

When reimbursing, you must bring the following information:

1, original ID card or social security card;

2, the original certificate of disease diagnosis issued by the designated medical institutions;

3, outpatient medical records, inspection, test results report and other original medical information;

4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;

6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods;

7. If it is an agent, you need to provide the original ID card of the agent.

Bring all the above information to the relevant departments of the local social security center. Upon examination, if the information is complete and meets the requirements, it can be handled immediately. When applying for reimbursement of outpatient medical expenses, the applicant should first deduct the amount allocated to the personal account of medical insurance in this social security year, and then verify the amount to be reimbursed.

Legal basis:

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

Article 26

The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28

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.

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.