First, one-stop reimbursement:
1, Qilu insurance settlement platform is directly connected with the local medical insurance system.
2. During the guarantee period, the medical expenses incurred by the insured in the local designated medical institutions for basic medical insurance that meet the requirements of hospitalization and outpatient basic medical insurance for chronic diseases and reimbursement of hospitalization and outpatient basic medical insurance for chronic diseases can be settled synchronously with basic medical insurance and serious illness insurance at the hospital end.
Second, off-site reimbursement:
1. If the insured person goes to a different place for medical treatment and the basic medical insurance is not settled immediately at the time of discharge, he needs to go back to the local basic medical insurance agency for reimbursement. Qilu Bao implements one-stop rapid compensation for medical treatment in different places. The insured person does not need to report the case, settle the account first when leaving the hospital, and complete the basic medical insurance reimbursement according to the medical insurance policy. The medical insurance system is connected with the insurance company. For those who meet the reimbursement requirements of Qilu Insurance, the system will automatically push the relevant information of the insured to the insurance company. For those who meet the reimbursement standards, the insurance company will contact the insured to provide ID cards, bank account numbers and other related materials for reimbursement, and decide whether to provide other paper claims application materials according to the actual audit situation.
2. If the insured goes to a different place for medical treatment, and the basic medical insurance has been settled immediately when he leaves the hospital, the insured needs to submit paper claims materials to the designated outlets for reimbursement, including the insured/applicant's valid identity certificate, hospitalization medical record, basic medical insurance settlement form, original medical expense voucher, expense detailed list, copy of bank card, etc.
The significance of Qilu Bao's hospitalization reimbursement is mainly reflected in the following aspects:
1, reduce the economic burden: hospitalization medical expenses are often very high, which is not a small expense for ordinary families. Qilu Bao's hospitalization reimbursement policy can reduce the financial burden of patients to a certain extent and avoid the family financial difficulties caused by high medical expenses.
2. Improve the level of medical security: Qilu Bao's hospitalization reimbursement policy can improve the level of medical security for patients, so that patients can get better treatment and services when they encounter major diseases, and improve the treatment effect and the quality of life of patients.
3. Promote the rational distribution of medical resources: through the hospitalization reimbursement policy, guide patients to choose medical institutions and doctors reasonably, promote the rational distribution and utilization of medical resources, and improve the utilization efficiency of medical resources.
4. Enhance social equity: The hospitalization reimbursement policy embodies social equity, enabling patients with different income levels to enjoy basic medical security and narrowing the medical service gap caused by differences in economic conditions.
To sum up, the implementation of Qilu Bao's hospitalization reimbursement policy is of great significance for protecting patients' medical rights and interests, reducing their economic burden and promoting the rational allocation of medical resources.
Legal basis:
People's Republic of China (PRC) social insurance law
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.