1, the injury must be caused by work or study;
2. If you need to go to the hospital for treatment, you should issue relevant diagnosis and expense list;
3. Injuries are diseases or items within the scope of medical insurance, such as fractures and sprains.
Medical insurance reimbursement conditions:
1. Confirm the insured status: before seeking medical treatment, you need to confirm that you have participated in local medical insurance, which can be confirmed by means of social security card and medical insurance certificate;
2. Medical category: Medical insurance generally only reimburses therapeutic medical behaviors, such as outpatient service, hospitalization, surgery and examination. Some cosmetic medical behaviors, such as dental beauty and plastic surgery, are usually not covered by medical insurance reimbursement;
3. Medical expenses: Medical insurance will only reimburse medical expenses that meet the requirements, such as medical expenses, medicine expenses, examination expenses, operation expenses, etc. Personal expenses, medical insurance will not be reimbursed;
4. Hospital qualification: Medical insurance will only reimburse the medical expenses of legally operated medical institutions, such as public hospitals and qualified private hospitals. Medical insurance will not be reimbursed for illegal medical institutions or clinics.
To sum up, the scope and proportion of medical insurance reimbursement are different, depending on the local medical insurance policy. At the same time, if the injury is caused by personal reasons, such as engaging in high-risk sports privately, medical insurance may not be reimbursed.
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.