Can accidental injury hospitalization social security medical insurance be reimbursed?

Accidental injury hospitalization can be reimbursed by social security and medical insurance.

First, the basic conditions of social security medical reimbursement

First of all, the insured needs to pay social insurance premiums in full and on time to ensure that their social security accounts are in a normal state. This is a prerequisite for enjoying social security medical care.

Secondly, after the insured suffers accidental injury, he needs to go to a qualified medical institution for treatment, and keep relevant medical expense invoices and diagnosis certificates. These materials are an important basis for subsequent applications for social security medical reimbursement.

Second, the social security medical reimbursement process

1. During hospitalization, the insured shall consult the social security window of the hospital for relevant reimbursement policies and procedures.

2. After the treatment, the insured person needs to prepare complete medical expense invoices, diagnosis certificates, hospital medical records and other related materials.

3. The insured person shall fill in the application form for social security medical reimbursement according to the requirements of the hospital or social security department, and submit relevant materials together.

4. The social security department shall review the submitted materials and confirm that they meet the reimbursement conditions, and reimburse them according to the prescribed proportion and standards.

It should be noted that there may be some differences in social security medical policies in different regions, and the specific reimbursement standards and procedures may be different. Therefore, it is best for the insured to know the local specific policies before applying for reimbursement.

Three, the scope and limitations of social security medical reimbursement

The scope of social security medical reimbursement generally includes medical expenses such as medicine, medical treatment, examination, operation and hospitalization. However, it should be noted that some special items or high expenses may not be within the scope of reimbursement, or there may be certain reimbursement ratio restrictions. Therefore, it is best for the insured to understand the scope and limitations of social security medical reimbursement before going to the hospital.

To sum up:

Accidental injury hospitalization, social security medical treatment can be reimbursed. The insured person needs to meet the basic conditions and submit relevant materials for reimbursement in accordance with the prescribed procedures. There may be differences in different regions, so it is best for the insured to understand the specific local policies before applying. At the same time, we should also pay attention to the reimbursement scope and restrictions of social security medical care, so as to make a reasonable choice when seeking medical treatment.

Legal basis:

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

Article 28 provides that:

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 provides that:

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.