2. After the insured is hospitalized, the deductible line of the overall fund is divided into three grades: tertiary hospital 1000 yuan, secondary hospital 600 yuan, and primary hospital 400 yuan. In a basic medical insurance settlement year, the medical expenses for multiple hospitalizations are calculated cumulatively.
3, the insured due to illness need referral (hospitalization), shall be approved by the designated medical institutions (three or more) deputy chief physician or chief physician diagnosis put forward referral (hospitalization) opinions, by the unit to fill in the application form, after the designated medical institutions medical insurance management department audit report to the municipal (District) social security institutions for approval for referral (hospitalization) procedures. Then go through the discharge formalities, the inpatient department will issue a list of expenses after checking out, and take this list and the materials copied in the ward to the medical insurance center. After preliminary examination, if the materials are incomplete, they will be returned as soon as possible. Then, I will tell you to get the audit notice in five working days.
4. When the designated medical institutions are discharged from the hospital, the reimbursement amount and the amount payable by individuals shall be calculated by the designated medical institutions, and the reimbursement amount shall be settled by the designated medical institutions and urban social insurance agencies, and the amount payable by individuals shall be settled by the designated medical institutions and the insured.
5. When visiting a designated hospital, show the medical insurance card to prove the identity and registration of the insured. Individuals do not need to pay first and then reimburse, and the part of medical insurance reimbursement can be directly settled by medical insurance and hospitals. Only when the account is settled, the self-funded part will be paid by the balance of the medical insurance card or cash. As a result, after three working days, I received a call from the medical insurance center. After I got the bill, I went to the inpatient department to check out again, deducted the reimbursement from the original hospitalization deposit and returned it to the inpatient department together with the balance of hospitalization expenses. This is the end of hospitalization reimbursement.
Legal basis: Article 25 of the Social Insurance Law The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.