1, ten prohibited behaviors of designated medical institutions in using medical insurance funds, such as decomposition of hospitalization, hanging bed hospitalization, repeated charges, excessive charges, drug exchange, medical consumables, diagnosis and treatment items and service facilities;
2. Five behaviors of designated medical institutions in using medical insurance funds, such as handing over my medical insurance certificate to others for use under an assumed name, repeatedly enjoying medical insurance benefits, reselling drugs by taking advantage of the opportunity to enjoy medical insurance benefits, accepting cash or physical return or obtaining other illegal benefits.
3. The behavior red line of designated pharmacies, such as swapping drugs, swapping drugs that can be paid by medical insurance funds with daily necessities and health care products, forging prescriptions or selling drugs that can only be purchased by prescription to people without prescriptions;
4. Inducing and assisting others to seek medical treatment or purchase medicines falsely, forging, altering, concealing, altering or destroying medical documents, medical certificates, accounting vouchers, electronic information and other relevant materials, and fabricating medical services.
Medical insurance reimbursement materials:
1, medical insurance card: hold a valid medical insurance card;
2. Medical records: medical records are needed, including the department, date, diagnosis result and treatment plan.
3. Prescription note: the original and photocopy of the prescription note are required, including the name, dosage, usage and time of use of the drug;
4. Receipt: the original and photocopy of the receipt for drug purchase or treatment expenses shall be provided, including the name, quantity, unit price and amount of the drug;
5. Hospitalization records: In case of hospitalization, hospitalization records, discharge summary and other hospitalization records shall be provided;
6. Other relevant materials: such as outpatient medical bills, inpatient medical bills, inspection reports issued by hospitals, laboratory tests, etc.
To sum up, the medical insurance reimbursement process may be slightly different in different regions, and the specific operation steps can be adjusted according to local policies and actual conditions.
Legal basis:
People's Republic of China (PRC) social insurance law
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The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
essay
The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.
Article 4
Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights records, and require social insurance agencies to provide social insurance consultation and other related services.
Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.