How does social security reimburse medical expenses?

The method of social security reimbursement of medical expenses is:

1. When entering or leaving the hospital, you must go through the registration formalities with the medical insurance IC card at the medical insurance management window of each designated medical institution.

2. After the insured is hospitalized, the deductible line of the overall fund is divided into three grades: tertiary hospital 1000 yuan, secondary hospital 600 yuan, and primary hospital 400 yuan. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.

3, the insured due to illness need referral (hospitalization), shall be approved by the designated medical institutions (three or more) deputy chief physician or chief physician diagnosis put forward referral (hospitalization) opinions, by the unit to fill in the application form, after the approval of the designated medical institutions medical insurance management department reported to the municipal (District) social security institutions for referral (hospitalization) procedures.

4. When the designated medical institutions are discharged from the hospital, the reimbursement amount and the amount payable by individuals shall be calculated by the designated medical institutions, and the reimbursement amount shall be settled by the designated medical institutions and urban social insurance agencies, and the amount payable by individuals shall be settled by the designated medical institutions and the insured.

5. When visiting a designated hospital, show the medical insurance card to prove the identity and registration of the insured. Individuals do not need to pay first and then reimburse, and the part of medical insurance reimbursement can be directly settled by medical insurance and hospitals. Only when the account is settled, the self-funded part will be paid by the balance of the medical insurance card or cash.

What materials should be provided for reimbursement of medical expenses?

1, the original and photocopy of the insured's ID card (if entrusted by others, the original and photocopy of the client's ID card shall also be provided);

2. The original and photocopy of the insured's medical insurance card. If there is no medical insurance card, the insured shall provide the original and photocopy of his bank passbook (card);

3. The original and photocopy of the charge receipt;

4. Detailed list of hospitalization expenses (note: it is not a list of daily expenses);

5. Discharge summary or discharge record. If the discharge summary is handwritten on the medical record, copy the discharge summary and the cover of the medical record;

6, disease diagnosis certificate (death, death certificate must be provided).

In a word, using social security card to reimburse hospitalization expenses is divided into the following steps: hospitalization registration, expense settlement, hospitalization reimbursement, and personal self-funded partial settlement.

Legal basis:

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

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.