First, the medical insurance settlement procedures:
(1) Settlement procedures for inpatient and outpatient treatment of special diseases
Designated medical institutions shall submit 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 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.
(2) Emergency settlement procedures
The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions in the city and medical institutions in different places 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.
(three) resettlement procedures for resettlement personnel in different places
1. The resettlement personnel in different places are designated as 1-2 designated medical institutions by their units and reported to the medical insurance agency for the record.
2. The medical expenses incurred by the staff in different places who are sick at their place of residence in the designated medical institutions shall be paid in advance by themselves or their units. After the treatment, the unit shall settle the diagnosis and medical records, effective expense bills, compound prescriptions and hospitalization expense lists of the insured. Go to the social medical insurance agency on the specified date.
(4) Referral and settlement.
1. If the insured person is transferred to other medical institutions for diagnosis and treatment due to the conditions of designated medical institutions or specialized diseases, the approval form for referral and transfer shall be filled in. The reason for referral and transfer is put forward by the attending physician, the director of the department puts forward the opinion of referral and transfer, the medical institution medical insurance office reviews it, the dean in charge signs it, and it can be transferred only after being reported to the municipal medical insurance center for examination and approval.
2. Referral and transfer in principle, the city should be outside the city, and the province should be outside the province first. The city's referral regulations are carried out between designated medical institutions. The referral outside the city is proposed by the designated medical institutions above Grade III in this Municipality.
3. The medical expenses incurred after the insured person is referred to another hospital shall be paid by the individual or unit in cash. After the medical treatment, the insured person or his agent will submit the referral approval form, medical record certificate, prescription and valid documents to the medical insurance agency for reimbursement of hospitalization expenses that fall within the scope of the overall fund payment.
Second, the medical insurance reimbursement process and time:
For all participants, the reimbursement process is as follows:
(a) participating farmers to "new rural cooperative medical certificate" in the designated institutions for outpatient treatment, by the designated medical institutions according to the "new rural cooperative medical certificate" family outpatient account existing amount directly reduce medical expenses, the excess paid by participating farmers. Designated medical institutions shall settle accounts with agricultural medical institutions in a timely manner.
Participating farmers are hospitalized in designated medical institutions in cities, counties and townships, and are directly subsidized by designated medical institutions. Audit the medical expenses incurred by designated medical institutions, and prepay the subsidy amount according to the standards stipulated in the implementation measures.
(two) the participating farmers in the provincial designated medical institutions and non designated medical institutions hospitalization, all compensation to the township agricultural medical institutions. Hospitalization medical expenses, one-time less than 2000 yuan (including 2000 yuan) by the township (town) agricultural medical reimbursement, the township (town) agricultural medical audit, submitted to the county agricultural medical bureau for examination and approval before reimbursement.
(1) When applying for compensation, I need to bring my ID card, household registration book, new rural cooperative medical certificate (the original copies of these three certificates are kept below), valid hospitalization invoice of medical institution, discharge summary (or medical record), expense list and referral certificate.
(II) The participating farmers suffering from outpatient serious illness (chronic disease) shall go to the township (town) Agricultural Medical Office with their ID card, household registration book, new rural cooperative medical system, outpatient invoice and list, outpatient medical records, inspection report, and outpatient serious illness (chronic disease) certificate from a second-class hospital or a specialized hospital.
(III) For participating farmers who have participated in commercial insurance and students who have participated in student medical insurance, when both commercial insurance compensation and new rural cooperative medical system compensation are required after discharge, participating farmers should first submit the original hospitalization invoice and a copy of the invoice to the Agricultural Institute or the designated medical institution at the county level for compensation, and then pay the original hospitalization invoice to the commercial insurance company. Copies of invoices shall be kept by county-level agricultural medical institutions or designated medical institutions, but trauma patients can only be reimbursed by the original (except students).
(4) The hospitalization expenses shall be settled within a limited time, and the compensation and settlement procedures can be handled at any time within three months after discharge. Those who spend more than three months are deemed to have given up compensation on their own (migrant workers may delay until the end of the year). The amount of compensation payable by the Agricultural Medical Institute according to the standards stipulated in the Implementation Measures shall be paid to the participating farmers within 10 working days.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.