Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. The basic medical insurance fund consists of overall funds and individual accounts.
The basic medical insurance premiums paid by individual employees are all included in individual accounts; The basic medical insurance premium paid by the employer is divided into two parts, one part is included in the personal account, and the other part is used to establish the overall fund.
If the insured person is hospitalized in a designated networked hospital, he can directly settle the medical expenses on the spot when he is discharged. However, due to special circumstances, such as the insured seeking medical treatment in medical institutions in other provinces and cities, the insured must first pay medical expenses, and then go through the procedures for reimbursement of medical expenses at the social insurance institutions in the insured areas.
In this case, there is a time limit for medical insurance reimbursement when leaving the hospital. The time limit for reimbursement is different in different cities. For example, according to the current medical insurance policy in Shenzhen, if the insured person advances medical expenses, he should apply for reimbursement within 12 months from the date of the expenses or the date of discharge, and will not be reimbursed after the time limit.
For another example, the Measures for Settlement of Basic Medical Insurance for Urban and Rural Residents in Shanghai stipulates that sporadic reimbursement of insured persons shall be applied within 3 months from the date when the medical institution issues the receipt. Sporadic reimbursement of medical expenses shall be handled according to the medical expenses of the year when the expenses are settled. Simply put, there is a time limit for medical insurance reimbursement after discharge, and the insured must go through the medical insurance reimbursement procedures within the specified time.
To sum up, in order to ensure the safety of medical insurance funds, all regions in China have limited the time for reimbursement of medical insurance in different places. The deadline of medical insurance reimbursement time is different because of the actual situation in different places, so the reimbursement time is also different, but the basic requirement is 6 months to 1 year.
According to China's current medical insurance policy, it is generally not reimbursed if the medical insurance reimbursement time is exceeded. General medical expenses are reimbursed in the same year, not every other year. Those who are hospitalized on New Year's Eve should also settle and reimburse the medical expenses of that year. If it is overdue, it can't be reimbursed. Therefore, it is hoped that the insured can apply for reimbursement to the local medical insurance institution in time after the relevant expenses are incurred. For details, please call the local social security service hotline 12333.
This is the answer to the question: Is there a time limit for medical insurance reimbursement? Generally speaking, when you go to the hospital for treatment, you will calculate the reimbursement account of medical insurance when you check out, so you can directly reimburse it.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.
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.