Social medical insurance reimbursement is after discharge or transfer.
Designated medical institutions should report the expense list, hospitalization list and related materials of patients discharged from hospital last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination;
The medical insurance agency pre-allocated the hospitalization and outpatient co-ordination expenses for special diseases last month;
Insured persons suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase.
Medical insurance reimbursement, if the local medical reimbursement is generally 15 working days, the medical reimbursement in different places is generally 30 working days. Please consult the local social security bureau for details. Social medical insurance reimbursement is after discharge or transfer.
Settlement procedures for inpatient and outpatient treatment of special diseases:
Designated medical institutions should report the expense list, hospitalization list and related materials of patients discharged from hospital last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination;
The medical insurance agency pre-allocated the hospitalization and outpatient co-ordination expenses for special diseases last month;
Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.
Emergency settlement procedure:
The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions and medical institutions in different places in this city shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall handle the reimbursement procedures according to the provisions with the emergency hospitalization medical records, inspection, laboratory test sheets, invoices and detailed list of medical expenses.
1. What is the reimbursement rate for medical insurance?
Proportion of reimbursement of hospitalization medical expenses
The reimbursement rate of hospitalization medical expenses within the policy of first-class medical institutions is 95%; The reimbursement rate of hospitalization medical expenses within the policy of secondary medical institutions is 90%; The reimbursement rate of hospitalization medical expenses within the policy of tertiary medical institutions is 85%; The reimbursement rate of hospitalization medical expenses in the policy of government-run primary medical and health institutions is 95%.
Proportion of reimbursement for serious illness medical insurance
On the basis of the basic medical reimbursement for urban and rural residents who have participated in the urban residents' medical insurance and the new rural cooperative medical system, the individual shall bear the part of the compliance cost exceeding 654.38+0,000 yuan, and make compensation in four stages, namely, 50% for the part of 654.38+0-3,000 yuan, 60% for the part of 3-8,000 yuan and 70% for the part of 80-6.54 million yuan.
To sum up, if the local medical reimbursement generally arrives in 15 working days, the medical reimbursement in different places generally arrives in 30 working days; Commercial medical insurance claims usually take 1-3 working days, and it usually takes several weeks or even more than 30 days if claims are investigated.
Legal basis:
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.