Shanghai employees, retirees and people who participate in the basic medical insurance for urban and rural residents can apply for reimbursement and settlement of basic medical insurance expenses.
Emergency compensation
According to the relevant regulations, Shanghai medical insurance participants can apply for sporadic reimbursement of basic medical expenses, including medical expenses incurred in emergency departments of designated medical institutions in other provinces and cities. The information provided by the insured includes valid identity documents, medical insurance cards or social security cards, my bank debit cards, special receipts for emergency medical expenses, etc. , and apply for reimbursement in community affairs acceptance centers in towns and medical insurance centers in various districts; You can also apply for reimbursement online through the "one thing for medical expenses reimbursement" platform.
Outpatient reimbursement
For outpatient treatment in other provinces and cities, the new social security card can be directly settled in designated hospitals that have opened direct settlement in different places, or it can be reimbursed sporadically after full cash settlement. In addition, in the Yangtze River Delta Demonstration Zone, filing is not required, and the insured can make direct outpatient settlement in designated hospitals that have opened direct outpatient settlement in different places with the new social security card.
Two, apply for sporadic basic medical expenses reimbursement shall provide the following information:
1. Valid identity documents of the insured.
2. The medical insurance card or social security card of the insured and my bank debit card.
3. Special receipt for emergency medical expenses (detailed list is required), relevant medical history data and copies (such as inspection, laboratory image report, Chinese medicine prescription, etc.). ).
4. Special receipt for outpatient medical expenses (detailed list is required), notice of damage of medical insurance card, relevant medical history data and copies (such as inspection, laboratory test, video report, prescription of traditional Chinese medicine, etc.). ).
5. Special receipt of medical expenses in emergency observation room, summary of discharge (observation), list and copy of medical expenses in emergency observation room, relevant medical history data and copies.
6. Special receipt for hospitalization medical expenses, list and copy of hospitalization medical expenses, discharge summary and copy, relevant medical history data and copy.
7. Other relevant materials that medical insurance staff require the parties to supplement due to special circumstances.
8. If an agent is entrusted by others, the valid identity certificate of the agent shall also be provided.
Third, the handling process
1, emergency reimbursement
(1) window processing: if the insured person in Shanghai fails to file or handle the transfer of medical relationship, the medical expenses incurred in emergency or emergency hospitalization in other provinces and cities can apply for reimbursement at the township community affairs acceptance centers and district medical insurance centers with the above materials;
(2) Online processing: You can also apply for reimbursement online through "One thing for reimbursement of medical expenses" on the platform of "One Netcom Office".
Processing instructions
On-the-job employees, retirees and those who participate in the basic medical insurance for urban and rural residents in Shanghai can apply for reimbursement and settlement of basic medical insurance expenses online. After online application, the original invoice and paper materials need to be sent to the community acceptance center through logistics. The logistics and distribution expenses are borne by itself: Shanghai 10 yuan/piece, Jiangsu and Zhejiang 12 yuan/piece, Anhui 14 yuan/piece, and 20 yuan in other parts of China.
Application steps
Step 1: Open the official website of "Shanghai Netcom Office" and enter "One thing for medical expenses reimbursement" in the search box;
Website:
Step 2: Then click "One thing for reimbursement of medical expenses" in the jumped page;
Step 3: After successful registration, enter the application page, select basic medical expenses reimbursement, click Next, complete the information and upload relevant materials as required to apply for reimbursement. ;
2, outpatient reimbursement
For outpatient treatment in other provinces and cities, the new social security card can be directly settled in designated hospitals that have opened direct settlement in different places, or it can be reimbursed sporadically after full cash settlement. In addition, in the Yangtze River Delta Demonstration Zone, filing is not required, and the insured can make direct outpatient settlement in designated hospitals that have opened direct outpatient settlement in different places with the new social security card.
For more questions about medical insurance, please call the medical insurance hotline 12393.