Hunan medical insurance reimbursement process and required materials
Outpatient medical insurance reimbursement process
The following materials shall be carried with the reimbursement:
1. Original ID card or social security card
2. Original certificate of disease diagnosis issued by the specialist of the designated medical institution
3. Original copies of outpatient medical records, examinations, test result reports and other medical data
4. Original receipt of outpatient charges of financial and tax unified medical institutions
5. The detailed list of outpatient expenses printed by the hospital computer or the original payer of the doctor's prescription
6. Designated drugstore: unified invoice for tax commodity sales and original computer printed list
7. If it is handled on behalf of others, the original ID card of the agent shall be provided.
Bring all the above information to the relevant department of the local social security center to apply for handling. After review, if the information is complete and meets the conditions, it can be handled immediately. When applying for reimbursement of outpatient medical expenses, the applicant shall first deduct the amount transferred into the personal account of medical insurance in the current social insurance year, and then verify the amount to be reimbursed.
Inpatient medical insurance reimbursement process
1. When admission or discharge, you must take the medical insurance IC card to the medical insurance management window of each designated medical institution to handle the admission and exit registration procedures. When in hospital, the individual shall pay the medical fee deposit in advance and make up for more or less after discharge. Medical expenses incurred before hospitalization registration procedures are not included in the payment scope of basic medical insurance. If the inpatient fails to go through the hospitalization registration procedures in time due to emergency hospitalization, he/she shall go to the medical insurance management window to go through the hospitalization procedures with the emergency certificate the next day after admission (postponed in case of holidays), and the medical expenses exceeding the time limit shall be borne by himself/herself.
2. The starting line of the pooling fund for the insured after hospitalization: the starting line varies from place to place. Generally, it is 10% of the average annual salary of the city's employees in the previous year. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are accumulated.
3. If the insured person needs to be transferred to another hospital due to his/her illness, he/she must be diagnosed by the deputy chief physician or department director of the designated medical institution at or above the third level, and then put forward his/her opinion on the transfer (hospital). The unit where he/she belongs should fill in the application form. After the medical insurance management department of the designated medical institution reviews and agrees to report to the municipal (district) social security institution for approval, he/she can go through the transfer (hospital) procedures.
The transfer is limited to provincial special hospitals, whose expenses shall be paid by themselves first, and the reimbursement standard shall be 10% at their own expense, and then the reimbursable amount shall be calculated according to local regulations.
4. When a designated medical institution discharges from the hospital, each designated medical institution will calculate the medical insurance reimbursement amount and the amount that the individual should pay according to the relevant policies. The reimbursement amount is settled by the designated medical institution and the urban social insurance agency, and the amount that the individual should pay is settled by the designated medical institution and the insured person