Medical insurance, that is, social medical insurance, is a social welfare insurance system that compensates workers or urban and rural residents for economic losses caused by disease risks. The medical insurance fund will be established through contributions from employers and individuals and state financial subsidies. After the insured has incurred medical expenses, he shall reimburse the insured for the medical expenses according to a certain proportion, and give the insured economic compensation to avoid or reduce the economic risks caused by illness and treatment. Social medical insurance includes basic medical insurance for urban workers and basic medical insurance for urban and rural residents.

The specific information required for medical insurance audit is as follows:

1, original ID card or social security card;

2, the original certificate of disease diagnosis issued by the designated medical institutions;

3, outpatient medical records, inspection, test results report and other original medical information;

4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;

5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;

6. The original unified invoice and computer printed list of taxable goods sold by designated pharmacies;

7. If it is an agent, you need to provide the original ID card of the agent.

The specific process of medical insurance audit is as follows:

1, expense reporting units and individuals submit relevant reimbursement materials;

2, accepting personnel to review the submitted materials;

3. After the materials are complete, the first-instance personnel will verify, enter, settle and print the medical expense reimbursement form; If the materials are incomplete, inform the materials that need to be filled in time;

4. The auditor reviews the expenses, prints the settlement voucher, and transfers it to financial payment.

To sum up, medical insurance is an insurance to compensate medical expenses caused by diseases.

Legal basis:

Article 23 of People's Republic of China (PRC) Social Insurance Law

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium 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.