How to reimburse for medical insurance in other cities? The medical level of each city is different, and the medical treatment in big cities is relatively advanced. Therefore, many people in remote areas with relatively backward medical equipment will choose to see doctors in big cities. Can medical insurance in other cities be reimbursed? What is the reimbursement process? Let's learn about it together with small editors of sihai.com.
Reimbursement process of remote medical insurance:
1. The unit to which they belong shall designate 1-2 designated medical institutions where they live, and report to the medical insurance agency for filing;
2. The medical expenses incurred in the clinic by the designated medical institution of the place of residence where the staff from other places are ill shall be paid in advance by the person or the unit. After the treatment, the unit shall carry the medical certificate and medical record of the insured, effective expense bill, double prescription, hospitalization expense list, etc. to the social medical insurance agency on the specified date for settlement.
How to reimburse for medical treatment in other places?
First, it depends on the disease. Some diseases are not reimbursed;
Second: go to a regular hospital for medical treatment
Third: keep relevant invoices as reimbursement vouchers
1. Scope of hospital transfer outside the city
(1) If the insured person's condition is complex and critical, and cannot be diagnosed or does not have the conditions for diagnosis and treatment after being diagnosed and treated by local designated medical institutions (excluding specialized hospitals) above level II (including level II).
(2) Difficult diseases that cannot be diagnosed in the local top level hospital due to technical and equipment conditions.
Procedures for transferring hospitals outside the city
The specialized director of the designated medical institution shall apply, fill in the application form of Jiangmen basic medical insurance for transfer (diagnosis) outside the city, which shall be examined and sealed by the medical department, and the insured or his relatives shall report to the social insurance agency for approval before going through the transfer procedures.
Settlement of transferred hospital outside the city
The medical expenses approved to be transferred to non designated medical institutions outside the city shall be paid in advance by the insured, and the relevant materials shall be carried out for reimbursement within 2 months.
2. Hospitalization scope of non designated medical institutions
(1) If the insured person suffers from acute illness and is hospitalized in this city or leaves this city (excluding going to Hong Kong, Macao, Taiwan and abroad) due to business trip, tourism, home visit and other reasons.
(2) Urban and rural medical insurance insured persons are ill and hospitalized during their long-term residence outside the city (residence certificate issued by residential committee or village committee of the residence must be provided).
Hospitalization procedures of non designated medical institutions
Within 5 working days after hospitalization (2 working days for urban and rural medical insurance), the insured or their relatives shall go to the social insurance agency of the insured place to handle the hospitalization filing procedures of non designated medical institutions.
Hospitalization settlement of non designated medical institutions
After going through the in-hospital filing procedures for non designated medical institutions outside the city according to the regulations, they shall bring relevant materials to the social insurance agency of the insured place to go through the reimbursement procedures within 2 months after leaving the hospital.
3. Employee medical insurance personal agreement medical institution scope
First, the insured who has lived outside the city for a long time (the residence certificate issued by the residential committee or village committee of the residence must be provided).
Second, the insured who is dispatched by the insured unit to a domestic non local institution (the certificate of dispatch of the unit must be provided).
Hospitalization procedures of non designated medical institutions
During the period when the insured is in a different place, the insured can select one or two designated medical institutions determined by the social insurance agency in the place of work or residence as the individual contracted medical institutions of the insured. The insured shall fill in the application form of Jiangmen basic medical insurance contracted medical institutions in a different place, and return to the insured after being examined and confirmed by the social insurance agency in a different place The local social insurance agency shall go through the filing formalities.
Hospitalization settlement of non designated medical institutions
Hospitalization: if hospitalization expenses are incurred after the insured goes through the hospitalization filing procedures of the individual agreed medical institution according to the regulations, the insured shall bring relevant materials to the social insurance agency of the insured location for reimbursement within 2 months after discharge.
Outpatient service for specific diseases: if the insured goes to the outpatient service for specific diseases of the medical institution as agreed by the insured, the medical expenses shall be paid by the insured. The insured shall go to the social insurance agency of the insured place to apply for reimbursement within 2 months with the ID card, social security card, outpatient charge receipt, charge list or schedule, special certificate for specific diseases and other relevant materials.
Ordinary outpatient service: for the medical insurance insured of domestic and foreign permanent employees who have been approved to handle the application of individual agreed medical institutions, the annual outpatient medical expenses incurred in the selected individual agreed medical institutions shall be reported to the social insurance agency of the insured location by themselves or their entrusted agent according to the date of the outpatient medical expenses and the relevant provisions of general outpatient medical expenses co-ordination Selling procedures.
Reimbursement procedures for medical insurance in other places
1. Materials to be submitted for reimbursement of outpatient expenses
Diagnosis certificate (original);
Special prescription for medical insurance (original and original);
Receipt and invoice issued by the hospital (original);
Examination and treatment details (original);
Beijing social security card (medical insurance card);
Full payment certificate (original).
2. Materials to be submitted for reimbursement of hospitalization expenses
Diagnosis certificate (original);
Receipt and invoice of the hospital (original);
Split sheet of hospitalization expenses of the hospital (original, usually attached in front of the detailed page);
Inpatient details of the hospital (original);
Beijing social security card (medical insurance card);
Full payment certificate (original);
Reimbursement process of medical insurance in other places
1. Hand over the manual reimbursement materials to the HR of the company
2. HR will then submit the materials to the social security center for review
3. After the approval, the social security center will pay the medical insurance reimbursement expenses to the company
4. Then the company will hand it over to the reimbursement staff