The medical insurance reimbursement process mainly includes three stages: the medical treatment stage, the settlement stage and the audit stage.
1. medical treatment stage: you must bring social security cards and other relevant documents when you go to the hospital to enjoy medical insurance benefits. At this stage, you should know about reimbursable drugs, medical items and other related information.
2. Settlement stage: When paying, you should show your social security card and other relevant documents, and the hospital will conduct preliminary examination and then settle online. At this time, you should pay attention to check the expense details, especially the self-funded part.
3. Audit stage: After the expenses are settled, the relevant departments will audit the medical expenses to confirm whether they meet the medical insurance policy. Generally speaking, the self-funded part should be submitted to the relevant departments for review within the specified time.
For self-funded medical expenses, you can apply for medical insurance reimbursement through the following steps:
1. Collect relevant supporting materials: in the payment stage, ask for a detailed list of medical expenses, invoices and related receipts for preparation. In addition, if the consequences continue to be reported in different places, relevant supporting materials need to be prepared in advance.
2. Submit an application: According to the relevant regulations, you can bring the above supporting materials to the local medical insurance agency for reimbursement within a period of time (usually several months) after the expenses occur. Different places and regions may have different regulations. For details, please consult relevant local authorities for detailed application process and time limit.
3. Waiting for approval: After submitting the application, the medical insurance agency will review the received materials for a period of time to see if they can enter. Please be patient.
4. Approval and issuance: If the materials are complete and meet the policy requirements, the handling agency will notify the applicant to approve the overdue materials, and ask the applicant to cancel the required funds and withdraw relevant information such as bank accounts in order to receive the funds. Generally speaking, the funds will be directly credited to the applicant's bank account.
5. Failing the audit and subsequent treatment: If the audit fails, the medical insurance agency will inform the reason and return the application. Please prepare supplementary materials according to the information provided, or seek other channels to help solve the problem.
To sum up: medical insurance policies in different regions may be different, and local policies should prevail. When applying for reimbursement at your own expense, you must consult the relevant policies and requirements of the local medical insurance agency in detail. At the same time, if you encounter special circumstances or other problems, you can always consult the relevant local departments.
Legal basis:
Detailed Rules for the Implementation of People's Republic of China (PRC) Social Insurance Law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid from the basic medical insurance fund in accordance with state regulations.
Article 29
The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by the social insurance agency and medical institutions and pharmaceutical business units, and the social insurance administrative department and the health administrative department shall establish a medical expenses settlement system in different places to facilitate the insured to enjoy the basic medical insurance benefits.