The direct settlement service of medical outpatient fees in the Yangtze River Delta covers all the overall planning areas in Shanghai, Jiangsu, Zhejiang and Anhui provinces and cities. Therefore, Suzhou medical insurance insured people go to Shanghai for medical treatment, and the outpatient expenses can be settled directly.
The Yangtze River Delta region has realized the "one card" of medical insurance. The basis of medical insurance card is the interconnection of information. Shanghai medical insurance department took the lead in developing the direct settlement information platform for off-site clinics in the Yangtze River Delta, which is compatible with the information systems of thousands of hospitals in various cities. Through the three provinces and one city, we will persist in promoting interconnection, let information "run more roads" and let the people run less errands.
Medical insurance coverage:
1, drug reimbursement for basic medical insurance
Our country now divides drugs into three categories: A, B and C, among which A drugs are within the scope of medical insurance, so medical insurance can only reimburse A drugs, and B and C drugs cannot be reimbursed;
2. Reimbursement of basic medical service facilities
This reimbursement scope mainly refers to bed fees, first-aid bed fees, consulting fees, etc. Expenses incurred by the insured in the process of diagnosis, treatment and nursing in designated medical insurance institutions;
3, the basic medical insurance treatment project reimbursement
It must be a safe and effective diagnosis and treatment, and the charging standard shall be determined by the price department. Need to be treated in a designated medical institution.
Medical insurance reimbursement process:
1, diagnosed and treated in the designated medical insurance hospital.
Every city will have designated hospitals for medical insurance. Only when you are treated in a designated medical insurance hospital can you be reimbursed by medical insurance. Therefore, if you want to use medical insurance, you must go to the designated hospital for medical insurance and go through the relevant registration procedures;
2. Prepare discharge information
Prepare discharge materials in advance when you leave the hospital, such as disease diagnosis, discharge records, medical records, etc. Usually talk to the doctor during treatment. If we need these materials, the doctor will help us prepare them. You'd better make a copy of these materials after you get them. One is submitted to the medical insurance reimbursement office, and the other is reserved for use;
3. Discharge settlement
Take the hospitalization list and invoice to the hospital for settlement. After that, you can take the relevant information to the medical insurance reimbursement department for reimbursement review;
4. Wait for the expense reimbursement to arrive.
A receipt will be received after the data is handed over, and the reimbursement amount will be received within 15 days. You just have to wait patiently.
To sum up, medical insurance, like other types of insurance, collects medical insurance premiums from people threatened by diseases in advance in the form of contracts and establishes medical insurance funds; When the insured goes to a medical institution for medical treatment, the medical insurance institution will give him some economic compensation.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.