1, accepted, urban insured persons submitted to the medical insurance settlement section of Zhanjiang Social Insurance Fund Administration; The county insured person shall submit it to the medical insurance unit of the county social insurance fund management bureau. The receptionist verifies the reimbursement materials and makes an acceptance decision on the spot. The acceptance is as follows:

(1) If the insured person meets the conditions for reimbursement, and the materials are complete, the format is standardized, and the legal form is met, it will be accepted, and the Receipt for Acceptance of Hospitalization Expense Reimbursement of the Insured Employee of Zhanjiang Medical Insurance will be issued;

(2) If the insured person does not meet the eligibility for reimbursement or the materials are incomplete and do not meet the statutory form, the receptionist will not accept it and inform the insured person.

2. After the approval, the auditor will review the reimbursement materials. The audit is as follows:

(1) If it meets the examination and approval conditions, it shall issue the List of Partial Medical Expenses Reimbursement and Payment of Basic Medical Insurance for Urban Employees in Zhanjiang City, and affix the seal of the implementing organ;

(2) If it is not passed, tell the reason. The business process takes about 20 working days.

3. Receive the payment list.

legal ground

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

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations. Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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. Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.