Insured persons with special diseases can apply to the handling window of the social security center with the application form for outpatient special diseases, discharge records, outpatient medical records and related inspection reports issued by designated hospitals at or above the second level, and the related expenses incurred after the application is approved can be reimbursed according to the policy.
The reimbursement process of work-related injury medical insurance is as follows:
1. When registering in hospital: you need to show your medical insurance card and ID card. The hospital will check the personal data and payment of the insured person in the medical insurance information system and handle the admission procedures for them;
2. During hospitalization: Please remind doctors that the use of self-funded drugs, diagnosis and treatment items and medical service facilities must be signed and agreed by patients or their families;
3. Discharge: If the hospitalization meets the discharge standard, the attending doctor will issue a discharge notice, and the insured will go to the discharge office with the discharge notice and medical insurance card for settlement. It usually takes no more than 7 days to get medicine from the hospital. At the time of discharge settlement, the insured person or his family members shall sign the medical insurance expense settlement form for confirmation.
Required information:
1, the original medical insurance card and its front and back copies;
2. The original invoice for hospitalization is stamped with the seal of the charging business of the medical institution;
3. Detailed summary list of hospitalization;
4, medical institutions stamped diagnosis proof materials;
5, the first page of hospital medical records or admission records;
6. A copy of the discharge summary is stamped with the special seal for medical records management of medical institutions.
To sum up, the insured first needs to go through the confirmation procedures of medical insurance in different places, and then go to designated medical institutions in different places for medical treatment. The insured person's hospitalization, including outpatient treatment of specific items, can be carried out in local designated medical institutions, and the medical expenses will be paid in advance by individuals.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
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.