The reimbursement process of medical insurance in different places in Hebei Province

Legal Analysis: Interpreting the New Policy of Hebei Medical Insurance Reimbursement Process and Reimbursement Ratio

Medical insurance refers to social medical insurance, which is a social insurance system established to provide basic medical needs for workers within the scope of protection. The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund. In this article, please introduce the related knowledge of Hebei medical insurance reimbursement. It mainly includes Hebei medical insurance reimbursement process, Hebei medical insurance reimbursement ratio, Hebei medical insurance reimbursement policy and other information.

First, Hebei Province medical insurance reimbursement process and required materials

First, seek medical treatment in different places.

There is no clear legal definition of medical treatment in different places. In social medical insurance coverage, "off-site" generally refers to other areas in China outside the insured's overall planning area, and "seeking medical treatment" refers to the insured's medical treatment behavior, which can be simply defined as the insured's medical treatment behavior outside its overall planning area.

"Off-site medical treatment" is generally divided into three situations:

(1) One-time medical treatment in different places, including acute treatment during business trip and tourism, and patients voluntarily transferring to other places for medical treatment, has the problem that medical expenses cannot be settled in time.

(2) Short-term and medium-term mobile medical care for people whose work place is not in the insured place, including the personnel stationed in various places of the unit and the local employees of the accredited institutions. Another situation is that the whole army is in a state of mobility.

(3) medical care for retirees who have been resettled in different places for a long time.

According to the current policy, hospitalization in places other than medical insurance can only be reimbursed in two cases.

The first is emergency treatment in different places.

Second, he was transferred to other places after seeking medical treatment locally.

In addition, in case of the above (3), medical insurance should be arranged in time, otherwise it will not be reimbursed.

Second, how to reimburse medical insurance in different places?

(1) Conditions for reimbursement of medical insurance in different places

(1)IC card, basic medical insurance card (green photo) or basic medical handbook for urban residents.

(2) Effective receipt voucher (invoice).

(3) Summary of hospitalization expenses, medical insurance referral letter and discharge certificate.

(4) Hospitalization materials: the first page of hospitalization medical records, admission records, operation records, discharge summary, large-scale inspection reports, long-term doctor's orders and temporary doctor's orders (sealed by the medical institution).

(B) Medical insurance reimbursement process in different places

(1) Discharge summary, invoice and medication list issued by different hospitals.

(2) My ID card, medical insurance card and medical certificate issued by the company (official seal of the company is required). If the company is not insured, it does not need a medical certificate issued by the company.

(3) The transfer certificate issued by the local hospital needs to be issued by the attending physician, and then signed by the director of the department where the attending physician is located, and then the transfer certificate is handled in the hospital medical insurance office.

(4) The reimbursement for medical treatment in different places is less 10% than that for medical treatment in local areas, and the absence of transfer certificate issued by local hospitals is 20% less.

(5) Bring the above information to the local medical insurance office, and you can get the money on the same day.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.