What is the proportion of medical insurance reimbursement in Shenzhen in 2023?

What are the relevant provisions of "What is the proportion and process of medical insurance reimbursement in Shenzhen in 2022"? How can we legally safeguard our legitimate rights and interests? If you want to know more about the proportion and process of medical reimbursement in Shenzhen, please take a look with me.

What is the proportion of medical insurance reimbursement in Shenzhen in 2022?

Offline processing flow:

Window processing flow:

1. Application 1) Applicants who take the number apply in the district or street government service hall. According to the applicant's work needs, the hall consultation guides the applicant to the pager in the hall to take the number in turn, and the system automatically generates and prints the processing sequence number, and the applicant queues up to handle the work according to the processing sequence number; 2) Submit an application The applicant submits an application in the window of the government service hall.

2. Acceptance personnel accept paper materials on the spot.

3. The contents of the acceptance review are: whether the applicant meets the application qualification; Whether the application materials are complete, whether the format is standardized and whether it conforms to the statutory form; Whether it belongs to the scope of acceptance of this department; Whether to accept it or not. If it meets the acceptance conditions, a registration form stamped with the record seal shall be issued after the acceptance.

4. 1 working day to review the business accepted by the service hall window;

5. Review the relevant information, and give a decision of approval or disapproval after confirmation, that is, the business is completed.

6. The service record business processing result is immediately pushed to the personal online service system.

Online processing flow:

1. The applicant directly logs in or jumps to the personal online service system of our city through the Guangdong Government Affairs Service Network, selects the menu option of "Medical Insurance-Record of Insured Persons Living in Different Places in Our City", fills in the application information according to the prompts, and submits it after confirming that the information is correct;

2. After accepting the application submitted by the applicant online, the system will automatically accept it;

3, the system audit system audit record information;

4. Real-time background verification of the approval system, uploading the filing information to national and provincial platforms;

5. Immediately complete the correct filing information of the business system and upload it successfully (batch in seconds);

6. The filing service results are immediately pushed to the personal online service system.

The object of reimbursement for medical treatment in different places in Shenzhen medical insurance

In Shenzhen, the hospitalization expenses of four types of medical people, such as resettlement and retirement, long-term residence in different places, permanent work in different places and referral in different places, can be directly reimbursed in different places.

Scope of reimbursement for medical treatment in Shenzhen medical insurance in different places

(1) reimbursement of hospitalization expenses

With the normal identity of the city's basic medical insurance one, two (children), three insured, off-site hospitalization basic medical expenses, local supplementary medical expenses, including self-treatment, referral, permanent residence in the mainland and other types of hospitalization.

(2) reimbursement of outpatient medical expenses

Including general outpatient reimbursement, outpatient annual overrun, outpatient special examination reimbursement, outpatient serious illness reimbursement and other types.

1. General reimbursement for outpatient service: first-class insured of basic medical insurance, insured with balance in personal account.

2. Out-of-year outpatient service exceeds the limit: the first-class insured of basic medical insurance has been insured for 12 months before seeing a doctor, which is in line with one of the situations of applying for permanent residence in the mainland or referral outside the city.

3. Reimbursement for special outpatient inspection: The insured person of Class I of basic medical insurance meets one of the situations of applying for permanent residence in the Mainland or referral outside the city.

4. Reimbursement for serious illness outpatient service: registered in Shenzhen for serious illness outpatient service, meeting the requirements of primary, secondary (children) and tertiary insured persons in basic medical insurance, and having permanent residence in the Mainland or referral outside the city.

Remarks: maternity insurance is not included in this business for the time being (Shenzhen maternity insurance reimburses medical expenses and enterprises enjoy maternity allowance).

Materials required for reimbursement of medical treatment in Shenzhen medical insurance in different places

(1) reimbursement of outpatient medical expenses

Necessary materials

1, the social security card of the insured. If an agent is entrusted, the agent's ID card (original inspection and copy of receipt) shall also be provided;

2, the original charge receipt stamped with the official seal of the hospital (printed by the financial department or the tax department) (original);

3. List of expenses stamped with the official seal of the hospital (original);

4. Bank passbook or bank card of the insured (provided by the insured who has not applied for financial social security card, Shenzhen ICBC, China Construction Bank, Agricultural Bank of China, Bank of China and China Merchants Bank) (check the original and receive a copy);

Supplementary material

5. When reimbursement of outpatient serious illness expenses is required, it is required to provide: medication plan or treatment plan, which needs to be stamped with the official seal of the hospital (original receipt);

6. According to the relevant regulations of the state, Guangdong Province and Shenzhen City, other materials required to complete the audit need to be stamped with the official seal of the hospital (such as using drugs, diagnosis and treatment items and service facilities limited in the medical insurance catalogue, corresponding clinical diagnosis certificates, inspection reports and other materials are required. Can be provided by the insured for the first time or after the handling department issues a notice of correction) (original).

(2) reimbursement of general medical hospitalization expenses

Necessary materials

1, the social security card of the insured. If an agent is entrusted, the agent's ID card (original inspection and copy of receipt) shall also be provided;

2, the original charge receipt stamped with the official seal of the hospital (printed by the financial department or the tax department) (original);

3. List of expenses stamped with the official seal of the hospital (original);

4. Discharge record or discharge summary with official seal (original);

5. Bank passbook or bank card of the insured (provided by the insured who has not applied for financial social security card, Shenzhen ICBC, China Construction Bank, Agricultural Bank of China, Bank of China and China Merchants Bank) (check the original and receive a copy);

Supplementary material

6, the use of disposable medical materials with a unit price of more than 1000 yuan, installation or replacement of artificial organs, it is necessary to provide a copy of the barcode of the material or a certificate issued by the hospital that the material is indeed domestic or imported, and it is necessary to affix the official seal of the hospital (original);

7. To apply for accidental injury reimbursement, you need to fill in the Confirmation Letter of Injury of Victims of Social Insurance Accidents in Shenzhen at the same time; At the same time, you need to provide the admission record (original);

8. According to the relevant regulations of the state, Guangdong Province and Shenzhen City, other materials required to complete the audit need to be stamped with the official seal of the hospital (such as using drugs, diagnosis and treatment items and service facilities limited in the medical insurance catalogue, corresponding clinical diagnosis certificates, inspection reports and other materials are required. Can be provided by the insured for the first time or after the handling department issues a notice of correction) (original).

Remarks: The insured shall handle the medical expenses within 0/2 months from the date of hospitalization (from the date of discharge)/kloc, and will not be accepted after the deadline.

The reimbursement process of Shenzhen medical insurance for medical treatment in different places

The insured can hold the above materials and go through the reimbursement procedures at the local Shenzhen medical insurance reimbursement outlets.

Inquiry method of reimbursement results of medical insurance in different places in Shenzhen

When the insured handles business in outlets outside the province, he needs to pay attention to telling the staff his mobile phone number. If we don't need a paper "Social Medical Insurance Medical Expense Reimbursement Form", we will inform the reimbursement result by SMS; If you need a paper reimbursement form for social medical insurance medical expenses, please leave your mailing address, and we will choose postal service (postage paid).