1. After seeing a doctor, the insured person needs to submit medical invoices, medication schedules and other materials to the social security agency for reimbursement;

2. In the case of hospitalization, directly handle the settlement in the hospital medical insurance office;

3. The proportion and amount of reimbursement are limited by local policies, and outpatient service is usually lower than hospitalization;

4. The reimbursement process should be completed within the prescribed time limit.

The scope of medical insurance reimbursement for urban and rural residents:

1. outpatient expenses: including registration fees, medical treatment fees, examination fees, laboratory tests fees, treatment fees, operation fees, medicine fees, etc.

2. Hospitalization fee: including bed fee, nursing fee, examination fee, operation fee, medicine fee, material fee, treatment fee, etc.

3. Outpatient expenses for special diseases: for special diseases, such as chronic diseases and mental illness, outpatient expenses can also be reimbursed;

4. Drug expenses for chronic diseases: For patients with chronic diseases, the drug expenses for long-term use can be reimbursed;

5. Vaccination expenses: Medical insurance for urban and rural residents in some areas includes necessary vaccination expenses.

To sum up, medical insurance reimbursement for urban and rural residents needs to submit relevant materials to the social security agency, and hospitalization can be settled directly in the hospital. The reimbursement rate is affected by the policy, and outpatient service is generally lower than hospitalization, so the reimbursement process must be completed within the specified time.

Legal basis:

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

Article 35

The medical insurance fund shall pay the contributions stipulated by the insured and social medical insurance policies, pay medical insurance benefits, and maintain the balanced operation of the medical insurance fund.

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

Article 4

Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.

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.

Provisions of Beijing Municipality on Basic Medical Insurance

Article 36

In a settlement period, the medical expenses incurred by employees and retirees shall be calculated by stages and paid cumulatively according to the level of the hospital and the amount of expenses, and shall be shared by the basic medical insurance funds and individuals according to the following proportions:

(1) Medical expenses incurred in tertiary hospitals:

1. For the part with the minimum threshold of 30,000 yuan, 85% will be paid by the overall fund and15% by the employees;

2. For the part exceeding 30,000 yuan to 40,000 yuan, 90% shall be paid by the overall fund and10% by the employees;

3 more than 40 thousand yuan, the overall fund to pay 95%, workers pay 5%.

(two) medical expenses incurred in secondary hospitals:

1. For the part with the minimum threshold of 30,000 yuan, 87% will be paid by the overall fund and13% by the employees;

2 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 92%, 8% workers pay;

3 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.

(3) Medical expenses incurred by first-class hospitals and family beds:

1. 90% of the minimum threshold is 30,000 yuan, and 90% is paid by the overall fund and10% by the employees;

2 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 95%, workers pay 5%;

3 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.

(4) The individual contribution ratio of retirees is 60% of the employees.

However, the maximum amount of proportional payment of the basic medical insurance pooling fund shall not exceed the maximum payment limit stipulated in Article 33 of these Provisions.

When the payment ratio of the basic medical insurance fund listed in the first paragraph of this article needs to be adjusted, the municipal labor and social security administrative department shall, jointly with the municipal finance department, put forward an adjustment plan, which shall be promulgated and implemented after being approved by the Municipal People's government.