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How to reimburse outpatient medical insurance in Hunan
The reimbursement process of outpatient medical insurance in Hunan province;

1. For outpatient and inpatient treatment, the insured person must show his social security card and swipe his card for medical treatment. The outpatient department must inform the hospital of the treatment category (such as chronic disease and outpatient service). If the card card is not produced or the treatment category is not clear, the medical expenses incurred by the insured employees when they seek medical treatment will not be paid by the medical insurance fund;

2, the insured in the designated retail pharmacies to buy drugs, must show my citizen card, inform the treatment category (such as outpatient chronic diseases, special), according to the relevant policies to buy drugs, because of special circumstances by others purchasing drugs, must show the insured and the purchaser's identity card, and registered by the pharmacy;

3, outpatient co-ordinate the implementation of the first diagnosis and referral system based on community health service institutions. Insured persons can be first diagnosed or referred to community-managed medical institutions in designated community health service institutions for urban workers' basic medical insurance; Specialized hospitals can be used as the first medical institutions for all insured persons. If the insured person needs a referral, the first-visit medical institution shall be responsible for the referral, and emergency rescue is not subject to this restriction. After the outpatient chronic disease subsidy limit is used up, you can directly enjoy the outpatient co-ordination treatment from the next cost, without referring to the original chronic disease. After the subsidy limit for specific outpatient items is used up, the referral procedures must be handled according to the provisions of outpatient co-ordination, and ordinary medical records can be used to enjoy the outpatient co-ordination treatment, but drugs bought in pharmacies do not enjoy the outpatient co-ordination treatment.

The reimbursement process of hospitalization medical insurance:

1. When entering or leaving the hospital, you must go through the registration formalities with the medical insurance IC card at the medical insurance management window of each designated medical institution. When in hospital, the individual pays the deposit of medical expenses in advance, and pays more and less after discharge. Medical expenses incurred before hospitalization registration are not included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, the emergency certificate should be presented to the medical insurance management window the next day after admission (postponed in case of holidays), and the overdue medical expenses should be borne by themselves;

2. The deductible line of the overall fund after the insured person is hospitalized: the deductible line varies from place to place, which is generally 10% of the average annual salary of employees in the whole city in the previous year. In a basic medical insurance settlement year, the cumulative calculation of medical expenses for multiple hospitalizations;

3. If the insured person needs to be referred or transferred due to illness, the deputy chief physician or chief physician of the designated medical institution at or above the third level shall put forward the opinions of referral (hospital) after diagnosis, and the unit to which he belongs shall fill in the application form and go through the referral (hospital) formalities with the approval of the medical insurance management department of the designated medical institution.

The transfer is limited to provincial specialized hospitals, and the expenses are paid by me first. The reimbursement standard is 10% first, and then the reimbursable amount is calculated according to local regulations.

4. When the designated medical institutions are discharged from the hospital, the designated medical institutions will calculate the reimbursement amount of medical insurance and the amount that individuals should pay. The reimbursement amount will be settled by the designated medical institutions and urban social insurance agencies, and the amount that individuals should pay will be settled by the designated medical institutions and the insured.

To sum up, bring all the necessary information to the relevant departments of the local social security center. Upon examination, if the information is complete and meets the requirements, it can be handled immediately. When applying for reimbursement of outpatient medical expenses, the applicant should first deduct the amount allocated to the personal account of medical insurance in this social security year, and then verify the amount to be reimbursed.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.