If he has made a "real-time settlement" (that is, medical insurance settlement) in the hospital, the unit does not need to reimburse him.

if he doesn't have "real-time settlement", he needs to return all the documents to the unit, and the person in charge will enter them in the system, print out the declaration form and go to the district and county medical insurance for reimbursement.

materials: receipts, details, bottom party, social security card, declaration form and offer documents.

the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by the social security agency, medical institutions and pharmaceutical business units, which is called "direct settlement".

Procedures and procedures for employees to handle medical reimbursement:

1. Medical expenses incurred by the insured after hospitalization:

When the insured is hospitalized in a designated medical institution, he shall pay a certain amount of advance payment to the designated medical institution to pay the expenses that should be borne by the individual.

if the medical expenses incurred by the insured patients during hospitalization are within the scope of basic medical insurance payment, the designated medical institutions shall adopt the bookkeeping method, and the designated medical institutions shall settle the accounts with the municipal medical insurance center, while the expenses outside the scope of medical insurance payment shall be paid by the patients themselves.

if the hospitalization of inpatients in the basic medical insurance is over a year, the year shall be determined according to the end time of diagnosis and treatment.

2. Reimbursement for emergency treatment of insured persons in other places:

Insured persons who are hospitalized for emergency treatment of sudden diseases in other places due to business trips, family visits, tourism, etc. must register with the municipal medical insurance management center within three days from the date of hospitalization (holidays will be postponed).

After the end of treatment, only those who bring relevant materials to the municipal medical insurance management center and meet the requirements of the scope of emergency rescue diseases can be reimbursed, and the minimum payment standard and the proportion of personal responsibility are increased by 3%. Medical expenses that occur without declaration and registration and do not meet the scope of emergency rescue diseases will not be paid by the medical insurance pooling fund.

When reimbursing, you need to bring:

medical expense reimbursement bills, all medical expense details (including specific diagnosis and treatment items, drug expenses, quantity and unit price), copies of medical records (home page, course records, doctor's advice auxiliary inspection report, and stamped with the special seal for hospitalization), emergency diagnosis certificate, unit introduction letter and medical insurance card to the municipal medical insurance management center for reimbursement procedures.

3. Reimbursement of medical expenses for the insured who need to be transferred to other places for treatment:

If the insured can't be diagnosed and treated in our city due to his special condition, he can fill in the Approval Form for Transfer of Medical Insurance to Other Places for Treatment by the Economic Management Hospital (tertiary general hospital), and the director of the department puts forward the referral opinion. After the hospital medical insurance office reviews it, he can be transferred to a designated medical institution in another place for treatment with the approval of the municipal labor and social security administrative department. The longest time from the approval to hospitalization is no more than two.

The hospitalization expenses incurred shall be reimbursed according to the medical insurance policy, and the minimum payment standard and the self-payment ratio shall be increased by 3% accordingly. The expenses that have been hospitalized before approval and examination will not be paid by the medical insurance fund.

When reimbursing, you should bring:

medical expense receipt, all medical expense details (including specific diagnosis and treatment items, drug expense quantity and unit price), medical record copy (home page, course record, doctor's advice auxiliary inspection report, and stamped with the special seal for hospitalization), referral approval form and my medical insurance card.

Extended information:

Generally speaking, the economic development in different regions is different, so the reimbursement ratio is also different. The following is an explanation of the medical insurance ratio of employees in Beijing.

After getting medical insurance, if you are an on-the-job employee, you can only reimburse the medical expenses of more than 1,8 yuan after seeing a doctor in the outpatient and emergency department of the hospital, and the reimbursement rate is 5%. If it is a retiree under 7 years old, the expenses above 13 yuan can be reimbursed, and the proportion of reimbursement is 7%. If it is a retiree over 7 years old, 8% of the expenses above 1,3 yuan can be reimbursed.

No matter what kind of people, the maximum amount of outpatient and emergency medical expenses paid is 2, yuan. For example, if you are an on-the-job employee, and the cost of seeing a doctor in the outpatient department is 2,5 yuan, then 5% of 7 yuan can be reimbursed, that is, 35 yuan. ?

if it is hospitalization expenses, when the basic medical insurance is used for the first time in a year in 29, the minimum payment is 1,3 yuan for both employees and retirees. And the second and later hospitalization medical expenses, Qifubiaozhun determined by 5%, is 65 yuan. The maximum payment of the basic medical insurance pooling fund (hospitalization expenses) in one year is 7, yuan.

The reimbursement standard for hospitalization is related to the level of the hospital where the insured person lives. If the insured person lives in a tertiary hospital, the employee will pay 15%, that is, 85%, from the minimum payment standard to 3, yuan. 3, yuan to 4, yuan, 1% paid by employees and 9% reimbursed; If the expenses exceed 4, yuan to the maximum payment limit, 95% can be reimbursed, and employees only need to pay 5%.

The proportion of retirees' personal payment is 6% of the on-the-job (that is, the above-mentioned) employees, but all those below the minimum threshold are paid by individuals.

Baidu encyclopedia-medical insurance reimbursement ratio