How to co-ordinate hospital medical reimbursement

The steps of overall hospitalization medical reimbursement are as follows:

1. Choice of medical treatment: When medical treatment is needed, choose medical institutions designated by medical insurance to ensure that medical expenses are within the scope of medical insurance.

2. Settlement of medical treatment: Medical treatment in medical institutions with medical insurance electronic certificate or social security card will be paid by medical insurance pooling funds and individuals in proportion according to the medical insurance policy.

3. Reimbursement application: Apply for online or offline reimbursement according to the local medical insurance policy.

4. Review and reimbursement: The medical insurance department will review the application to verify the rationality of the expenses and the scope of medical insurance policies.

Overall insurance reimbursement ratio of medical insurance:

According to the actual expenditure of medical expenses and the reimbursement ratio stipulated in the medical insurance policy.

Generally speaking, the expenses that can be reimbursed by medical insurance include outpatient expenses, hospitalization expenses, operation expenses and medicine expenses. However, there are also some special medical items or drugs that may not be covered by the overall medical insurance and need to be paid at their own expense.

To sum up, there are still some restrictions on the reimbursement of medical insurance. For example, the insured person needs to seek medical treatment in a prescribed medical institution, and choosing a non-cooperative hospital or doctor may not be able to enjoy medical insurance reimbursement. In addition, some high-end medical items or drugs may need to provide additional application materials, which can only be reimbursed after being approved by the medical insurance department.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 6

Workers in designated medical institutions in accordance with the provisions of the general outpatient medical expenses, as well as in designated retail pharmacies in accordance with the provisions of the outpatient prescription drug costs, paid by the employee medical insurance fund in accordance with the provisions.