Legal Subjectivity: With the convenience of transportation, more and more people are moving from rural areas to cities to work. As a result, some people will need to seek medical treatment in other places due to emergencies. In order to reduce the cost of medical treatment, medical insurance reimbursement is required.

1. Medical insurance reimbursement process for medical treatment in other provinces (1) The insured person brings the discharge summary, invoice, medication schedule issued by the hospital for medical treatment in other places, and the certificate of medical treatment in other places issued by the unit to the local social security agency for reimbursement; (2) For hospitalization expenses

, drug fees, etc. can be settled directly at the medical insurance office of the hospital where you are treated.

2. How does medical insurance reimburse? Social medical insurance means that when workers fall ill, social insurance institutions provide appropriate subsidies or reimbursement for the medical expenses they need, so that workers can restore their health and working ability and participate in the social reproduction process as soon as possible.

Social medical insurance is an important part of social insurance and is generally undertaken by the government. The government will use economic means, administrative means, and legal means to enforce and organize management.

So how are the insured's medical expenses reimbursed? Medical insurance is divided into two accounts. The personal account. The money reflected in the medical insurance card can be used to buy medicines at designated pharmacies, pay for outpatient expenses and the personal out-of-pocket portion of hospitalization expenses.

Payment; the overall account is managed by the medical insurance center. Expenses incurred by the insured that are reimbursed by local medical insurance are paid from the overall account.

When seeking medical treatment (hospitalization), the medical insurance card must be presented to the designated hospital to prove the insured status. When settling the bill, the individual's self-paying part shall be paid by the individual with the medical insurance card or cash, and the part reimbursed by the medical insurance shall be settled by the medical insurance and the hospital.

, individuals do not need to pay first and then be reimbursed.

The medical expenses incurred in outpatient clinics are not reimbursable.

Of course, when social medical insurance implements reimbursement, it is reimbursed according to a certain proportion.

This reimbursement ratio is mainly divided into the following situations: (1) The reimbursement ratio of medical insurance is different in different hospitals. If a person spends 10,000 yuan in the hospital, if he is hospitalized in a first-level hospital, then 500 yuan will be subtracted first;

If you are hospitalized in a secondary hospital, you will first subtract 1,000 yuan; if you are hospitalized in a tertiary hospital, you will first subtract 2,000 yuan; then exclude "non-medical insurance drug expenses" and "other non-medical insurance coverage expenses", and the remaining

80% of the people who are currently employed will report, and 50% will be reported by those who are retired or unemployed.

(Note: Medical insurance reimbursement only covers Category A drugs, that is, drugs for medical insurance, Category B is for non-medical insurance use and cannot be reimbursed) (2) Inpatient medical reimbursement reimbursement ratio for active employees. Medical insurance hospitalization, the total cost excludes the self-pay part, and Category B expenses are paid first after 10%.

, the portion exceeding the hospital medical insurance threshold fee will enjoy the overall payment ratio.

Different hospital levels have different threshold fees and different proportions of coordinated payment.

The proportion of employee medical insurance is more than 80% (Wuhan City 82%/84%/87%), and the proportion of residents’ medical insurance is about 70% (Wuhan City 80%/65%/50%).

3. How much reimbursement will be made locally for medical treatment abroad (1) The reimbursement ratio varies from place to place and is subject to local regulations. The parties concerned can directly consult the local medical insurance office.

The medical expenses for out-of-town medical treatment are paid in advance by the individual. After the treatment is completed, the individual or his agent will go to the medical insurance center for reimbursement.

(2) The following materials need to be prepared for reimbursement of medical expenses for insured employees: 1. Personal medical insurance medical certificate; approval document from a second-class or above hospital (referral transfer form); 2. Hospitalization invoice and fee summary stamped by the hospital where the patient was treated

Checklist and discharge summary; 3. The original and copy of the identity card of the person or the agent and the valid bank card or passbook of the reimbursement person.

Legal objectivity: Article 28 of the "Social Insurance Law of the People's Republic of China" meets the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses, and shall be deducted from the basic medical insurance fund in accordance with national regulations.

Pay.

Article 29 of the "Social Insurance Law of the People's Republic of China" The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit.

The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.