Medical insurance reimbursement refers to the process in which insured persons pay part or all of their medical expenses from the medical insurance fund in accordance with prescribed procedures and standards during medical treatment.

As for the method of medical insurance reimbursement, it is mainly to directly deduct the funds in the medical insurance account, or to settle directly with the medical institution through the medical insurance settlement system, and the insured only needs to pay the remaining part.

1. The basic process of medical insurance reimbursement and medical settlement: When insured persons seek medical treatment in medical institutions, they need to present their medical insurance card or electronic voucher.

The medical institution will conduct preliminary accounting and classification of the medical expenses of the insured persons in accordance with the provisions of the medical insurance policy.

Expense declaration: Medical institutions upload the medical expense information of insured persons to the medical insurance settlement system and declare expenses.

The medical insurance settlement system will review and calculate the declared expenses.

Fee payment: After passing the review, the medical insurance settlement system will directly pay the portion that should be paid by the medical insurance fund to the medical institution, and the insured only needs to pay the remaining portion.

If there is a balance in the medical insurance account of the insured person, the funds in the medical insurance account can also be directly deducted.

2. Precautions for medical insurance reimbursement: Keep relevant vouchers: During the process of medical treatment, insured persons should properly keep relevant vouchers such as medical expense invoices and prescriptions for subsequent reimbursement.

Understand the medical insurance policy: Insured persons should understand the local medical insurance policy regulations, including reimbursement scope, reimbursement ratio, reimbursement limit, etc., so that they can correctly choose medical institutions and medical services when seeking medical treatment.

Go through reimbursement procedures in a timely manner: Insured persons should go through reimbursement procedures in a timely manner after seeking medical treatment to avoid being unable to reimburse or reducing the reimbursement ratio due to time delays.

To sum up: Medical insurance reimbursement is one of the important ways for insured persons to enjoy medical security rights.

During the process of medical treatment, insured persons should understand the basic procedures and precautions for medical insurance reimbursement, and handle reimbursement procedures in accordance with prescribed procedures and standards to ensure that their medical expenses can be reasonably paid.

Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China" stipulates: Medical expenses that meet the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be covered by the basic medical insurance in accordance with national regulations.

Paid from the fund.

Article 29 stipulates: 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.