In life, no matter what you do, there are certain rules and regulations. For example, medical insurance, the audit needs a certain process, but also to avoid some fish in troubled waters and fraud. In the process of medical insurance reimbursement, you need to bring relevant materials, otherwise the materials are not complete enough to handle. 1. What materials are needed for various medical insurance reimbursement? The materials to be provided by the clinic are: 1, my medical record book, medical record card 2, outpatient invoice and original, which need to be stamped with the hospital seal. 3. The materials required to provide my ID card for hospitalization are: 1, my medical record book, medical record card 2, hospitalization invoice and original, which need to be stamped with the hospital seal. 3. The general list of expenses needs to be stamped by the hospital. A copy of my ID card. Second, the process of medical insurance reimbursement 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 used to go through the hospitalization formalities at the medical insurance management window the 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 medical expenses for multiple hospitalizations are calculated cumulatively. 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. Three. How much can medical insurance be reimbursed? (1) The medical expenses of employees and retirees who meet the outpatient treatment conditions for serious and serious diseases shall be paid by the overall fund according to the following proportion, but individuals shall also bear a certain proportion: 1, 80% of employees seek medical treatment and 20% of individuals. 2. Retirees' medical care, 85% paid by the overall fund and 15 paid by individuals. (2) When the medical expenses of employees and retirees for hospitalization, outpatient emergency rescue or outpatient treatment of some serious and serious diseases exceed the "ceiling line" of the overall fund within an insurance year, the commercial insurance company shall be responsible for the claims according to the method of subsection calculation and cumulative compensation, but individuals shall also bear a certain proportion of the expenses, specifically, medical expenses ranging from 1 yuan to 1 000 yuan (inclusive). 2.65438+10,000 yuan to 200,000 yuan (inclusive) for medical expenses, 96% for large medical insurance premiums, and 4% for individuals; 3, more than 200 thousand yuan of medical expenses, large medical insurance premiums to pay 98%, individuals pay 2%. In a year, the highest proportion of large medical insurance premiums is 300,000 yuan per person. In addition, in an insurance year, if the medical expenses paid by individuals (excluding the medical expenses with the minimum threshold and the medical expenses that do not meet the requirements of basic medical insurance) are less than 30,000 yuan and more than 4,000 yuan, the commercial insurance company will give a one-time subsidy of 1 10,000 yuan. I hope that the above information about what materials are needed for various medical insurance reimbursement, the medical insurance reimbursement process and how much medical insurance can be reimbursed will be helpful.

Legal objectivity:

1. What does medical insurance reimbursement mean? In short, part of the expenses you pay for medical treatment is borne by the state or unit, and the part you pay is called reimbursement. China's medical insurance is divided into two parts: individual account and social pooling fund, which are jointly funded by units and individuals in accordance with the prescribed proportion to ensure citizens' basic medical needs. Among them, the overall fund is used to pay the hospitalization expenses, the personal account is used to pay the outpatient and emergency expenses and the drug purchase expenses of designated retail pharmacies, and the expenses that need to be borne by individuals in specific projects of hospitalization and outpatient services are also paid by personal accounts. If the funds in personal accounts are insufficient, they will be paid by individuals. 2. Reimbursement proportion range 1, outpatient and emergency medical expenses: the part that meets the requirements of basic medical insurance in the employee's year (11February 31February) exceeds 2,000 yuan. 2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan. 3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate. 4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement. 5. Hospitalization. After paying medical insurance for 20 years, you can enjoy medical insurance reimbursement after retirement.