Can employees be reimbursed for accidental injuries in medical insurance?

Employees' accidental injuries can be reimbursed in medical insurance.

If the insured suffers accidental injury and is hospitalized at his own expense, and the medical institution is a designated medical institution for medical insurance, after investigation and verification by the medical insurance handling department, the individual pays 20% of the medical expenses within the scope of medical insurance payment, and then reimburses according to the reimbursement ratio of the designated hospitals at the same level in our city.

When reimbursing, you need to bring the social security card that has activated the medical insurance function and financial function, the original hospitalization invoice, the discharge summary or discharge record, the original expense list stamped with the hospital seal, the explanatory materials related to accidental injuries, the instructions or barcodes of built-in materials, the relevant medical records and inspection and laboratory reports of restricted drugs, etc.

Medical insurance reimbursement process:

1. The agent needs to bring relevant materials, including the original ID card, the original medical card, the hospitalization certificate of the hospital, the discharge certificate, the charging documents during hospitalization, the corresponding medical records, inspection reports and other related materials, and apply for reimbursement at the social security agency;

2. After accepting the application, the regulatory authorities will review the application materials received, and after the approval, the settlement and payment will be completed on the same day;

3. The social security agency has passed the examination, and the applicant can receive the reimbursement expenses with relevant documents. Under normal circumstances, under the condition of complete information, all the reimbursement work can be completed on the same day, without having to run a few more times.

Matters needing attention in medical insurance reimbursement

1, drug purchase reimbursement

If the insured person needs to be reimbursed for purchasing drugs and needs to bring a medical insurance card to a designated medical institution or pharmacy for purchase, the medical expenses can be settled directly by credit card, and the drug purchase is not included in the social overall planning. All accounts are settled by personal account, and if the balance of personal account is used up, it can also be paid in cash.

2, outpatient reimbursement

You need to bring the original ID card and the medical certificate issued by the doctor to the relevant departments of the local social security center for processing. Those who meet the requirements after examination can apply directly. However, when the outpatient department reimburses, it is necessary to deduct the amount of the social security personal account in the current year and then check the reimbursement amount.

3, hospitalization reimbursement

When in hospital, the insured person needs to pay the deposit of medical expenses first, and when discharged, he will refund more and make up less. Medical expenses incurred before the hospitalization registration formalities shall not be reimbursed.

To sum up, the accidental injury of employee medical insurance can be reimbursed. If the insured suffers accidental injury and is hospitalized at his own expense, and the medical institution is a designated medical institution for medical insurance, after investigation and verification by the medical insurance handling department, the individual pays 20% of the medical expenses within the scope of medical insurance payment, and then reimburses according to the reimbursement ratio of the designated hospitals at the same level in our city.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

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. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.