How is the medical insurance for sick hospitalization reimbursed?

How is the medical insurance for sick hospitalization reimbursed?

Shortly after Xiao Wang joined the company, the company gave him five insurances and one gold. After a while, he gave Xiao Wang a medical insurance card. A year later, Xiao Wang was hospitalized due to illness. But Xiao Wang holds a medical insurance card and doesn't know how to reimburse medical insurance if he is hospitalized. And how to use medical insurance in hospitals?

Let's take you to know how to reimburse the sick hospitalization medical insurance.

First, 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. When in hospital, the individual pays the deposit of medical expenses first, and after discharge, he will refund more and make up less. Medical expenses incurred before hospitalization registration are not included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, the emergency certificate should be used to go through the hospitalization formalities at the medical insurance management window the day after admission (postponed in case of holidays), and the overdue medical expenses should be borne by themselves.

Second, the deductible line of the insured after hospitalization: the deductible line varies from place to place, and is generally 10% of the average annual salary of employees in this city in the previous year. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.

Third, if the insured person needs to be referred or transferred due to illness, the deputy chief physician or chief physician of the designated medical institution at or above the third level shall put forward the opinions of referral (hospital) after diagnosis, and the unit to which he belongs shall fill in the application form and go through the referral (hospital) formalities after the approval of the medical insurance management department of the designated medical institution.

The transfer is limited to provincial specialized hospitals, and the expenses are paid by me first. The reimbursement standard is 10% first, and then the reimbursable amount is calculated according to local regulations.

Four, when discharged from designated medical institutions, designated medical institutions will calculate the amount of medical insurance reimbursement and the amount that individuals should pay in accordance with relevant policies. The amount of reimbursement 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.

Materials to be submitted for declaration:

1, original receipt;

2, hospitalization expenses statement;

3, discharge diagnosis certificate;

4. Copy of observation certificate or death certificate;

5, drugs, examination and treatment costs, emergency observation need to be stamped with the "emergency chapter" medical insurance prescription or emergency prescription in the emergency department.

6, social security card, "urban medical insurance manual";

7, the hospital full checkout certificate and unit description.

PS: The most important material in the medical insurance reimbursement process is the expense list issued by the medical unit. Generally, when going through the discharge formalities after being cured, a diagnosis certificate should be issued to the attending doctor. When you go through the discharge formalities with the certificate, you can print out a list of expenses.

Handler:

1. The agent submits the reimbursement documents and other materials to the Social Insurance Fund Administration for acceptance.

2. After receiving the application materials, the accepting department shall complete the examination, settlement and payment on the same day.

3, the social insurance fund management bureau to review the materials and approve the application, the applicant to receive the "social medical insurance medical expenses reimbursement form", be reimbursed.

Note: If the application materials are incomplete and all contents need to be corrected, the applicant shall correct the materials within 5 days from the date of receiving the Notice of Corrected Materials. If no correction is made within the time limit, the application shall be deemed to have been withdrawn.

However, after the materials are corrected, the applicant may reapply within the statutory validity period. The applicant shall be reimbursed after receiving the Social Medical Insurance Medical Expense Reimbursement Form.