1. outpatient reimbursement: generally, after the reimbursement information is confirmed in the hospital, the medical insurance department will transfer the reimbursement amount to the employee's own bank card within 5- 10 working days, and the specific arrival time may be different according to different banks and regions;
2. Hospitalization reimbursement: After the general hospital confirms the reimbursement information, the medical insurance department will transfer the reimbursement amount to the hospital account within 20-30 working days, and the hospital will settle the reimbursement amount to the patient or directly deduct the hospitalization expenses according to the actual situation;
3. Special circumstances: medical insurance payment failed to arrive in time, which may be caused by incomplete information, incomplete data or medical institutions failing to pass the audit. It is necessary to contact the local medical insurance management department in time for verification and handling.
The use process of medical insurance card is generally as follows:
1. Handling medical insurance cards: holders of social security cards or electronic medical insurance cards can handle medical insurance cards at local social security or medical insurance management institutions. When handling, you need to provide ID card, social security card or medical insurance electronic card and other documents, pay a certain card handling fee, and then wait for the medical insurance card to be completed;
2. Inquire about medical insurance information before seeing a doctor: You can inquire about your own medical insurance information before seeing a doctor, including personal basic information, medical insurance type, reimbursement ratio, balance, etc. Inquire about the terminal and medical insurance APP through the medical insurance card.
3. Holding a card for medical treatment: When a cardholder goes to a medical institution for medical treatment, he/she needs to show his/her medical insurance card. Medical institutions will read the information on the medical insurance card through the medical insurance card reader to determine whether the card is valid and can be used. When seeking medical treatment, it should be noted that the medical insurance card can only be used within the prescribed medical institutions and medical services, otherwise it will not be reimbursed;
4. Medical insurance settlement: After the medical treatment is completed, the medical institution records the medical expenses in the electronic settlement system, and uploads the medical information to the medical insurance center through the medical insurance card reader for cost settlement. The medical insurance center calculates the expenses that should be reimbursed according to the medical insurance policy and individual payment, and credits the reimbursed expenses into the cardholder's medical insurance account;
5. Medical insurance account management: Cardholders can query their medical insurance account balance, historical reimbursement records and other information through the medical insurance APP and the medical insurance card query terminal, and manage and query the medical insurance account.
To sum up, the use process of medical insurance cards in different regions may be different, and the specific use process and policies can be consulted with local medical insurance management institutions or relevant departments. In addition, when using medical insurance cards, cardholders should abide by medical insurance policies and regulations, pay attention to the choice of medical treatment, and avoid violations and medical fraud.
Legal basis:
Article 26 of People's Republic of China (PRC) Social Insurance Law
The basic medical insurance for employees, the new rural cooperative medical system and the basic medical insurance for urban residents shall be implemented in accordance with state regulations.
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.
Article 30
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(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.