How to inquire the reimbursement balance of medical insurance outpatient service

The balance of medical insurance outpatient reimbursement can be queried in the following ways:

1. Online inquiry: log on to the official website of the social security of the insured place and enter the personal social security account number and password to inquire about the balance of the medical insurance account.

2. Social Security Center Inquiry: If there is a social security center nearby, you can directly go to the counter of the social security center to inquire. On the self-service inquiry machine of social security center, you can enter your personal ID card and social security card password to inquire about the balance and reimbursement of medical insurance account.

3. Pharmacy inquiry: In designated medical insurance pharmacies, you can inquire about the balance and reimbursement of medical insurance cards from the clerk. The specific operation may vary from region to region, because the medical insurance policies in different regions may be different. In addition, it should be noted that the display of the balance of medical insurance card generally has two parts: personal account balance and overall account balance.

Medical insurance is social medical insurance. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. The basic medical insurance fund consists of overall funds and individual accounts. 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.

Medical insurance reimbursement requires the following materials:

1, hospitalization medical record issued by the attending doctor when the individual is hospitalized;

2. List of hospitalization expenses;

3. Various invoices for hospitalization expenses;

4, hospital financial discharge summary;

5. The disease diagnosis certificate issued by the attending doctor;

6. The patient's ID card and household registration book;

7. Social security card for medical practitioners.

To sum up, the personal account balance can be used to directly pay the medical expenses of outpatient or pharmacy, while the balance of the overall account is managed by the medical insurance center, and the expenses incurred by the insured who meet the local medical insurance reimbursement conditions are paid by the overall account.

Legal basis:

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

Article 28

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

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.