Procedures and units for hospitalization reimbursement of basic medical insurance for urban workers?
The reimbursement process for medical insurance outpatient service, with the following information:
1. Original ID card or social security card;
2. The original disease diagnosis certificate issued by the specialist in the tertiary or secondary hospital of the designated medical institution;
3. Original medical information such as outpatient medical records, examinations and test result reports;
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. Designated pharmacies: the original unified invoice and computer-printed list of tax commodity sales;
7. If acting as an agent, provide the original ID card of the agent.
bring all the above information to the relevant departments of the local social security center to apply for it. If the information is complete and qualified after examination, it will be handled immediately. When applying for reimbursement of outpatient medical expenses, the applicant shall 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.
reimbursement process of medical insurance hospitalization:
1. When you enter or leave the hospital, you must go through the registration formalities at the medical insurance management window of each designated medical institution with the medical insurance IC card.
individuals should pay 2 yuan in advance for medical expenses when they are hospitalized, and pay more and less after they are discharged from hospital. Medical expenses incurred before the hospitalization registration formalities are not allowed to be included in the payment scope of basic medical insurance. If the emergency hospitalization fails to go through the hospitalization registration formalities in time, it should go through the hospitalization formalities at the medical insurance management window on the basis of the emergency certificate the next day after admission (holidays will be postponed). If the time limit exceeds, the medical expenses will be borne by itself.
2. The deductible line of the overall fund for the insured after hospitalization is divided into three grades:
tertiary hospital 1 yuan, secondary hospital 6 yuan and primary hospital 4 yuan. 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 to the hospital due to illness, he/she must be diagnosed by the deputy chief physician or department director of the designated medical institution (level 3 or above) and put forward the opinions of the referral (hospital). The unit where he/she works should fill in the application form, and go through the referral (hospital) formalities after being approved by the medical insurance management department of the designated medical institution. The transfer is limited to provincial special hospitals, and the expenses shall be paid by me first, and the reimbursement standard shall be 1% first, and then the reimbursable amount shall be calculated according to local regulations.
4. When the designated medical institutions leave the hospital, each designated medical institution will calculate the reimbursement amount and the amount that the individual should pay, and the reimbursement amount will be settled by the designated medical institutions and the urban social insurance agencies, and the amount that the individual should pay will be settled by the designated medical institutions and the insured himself.