According to the Regulations of China Municipality on Basic Medical Insurance for Urban Employees and relevant laws and regulations, the scope of medical insurance reimbursement is as follows:
1, drugs allowed to be reimbursed within the reimbursement scope of basic medical insurance;
2, within the scope of the basic medical insurance reimbursement allows reimbursement of diagnosis and treatment projects;
3 expenses incurred by medical service facilities that are allowed to be reimbursed within the scope of reimbursement of basic medical insurance. Reimbursement expenses are mainly paid by the overall fund, and individuals have to pay a corresponding part.
What information do you need for medical insurance reimbursement?
1, original ID card or social security card;
2, the original certificate of disease diagnosis issued by the designated medical institutions;
3, outpatient medical records, inspection, test results report and other original medical information;
4. Original receipt of outpatient charges of medical institutions with unified finance and taxation;
5. The detailed list of outpatient expenses printed by the hospital computer or the original payment of prescriptions issued by doctors;
6. Designated pharmacies: unified original invoices and computer-printed sales lists of taxable goods; 7. If it is an agent, you need to provide the original ID card of the agent.
Medical insurance reimbursement process
Bring all the above information to the relevant departments of the local social security center. Upon examination, if the information is complete and meets the requirements, it can be handled immediately.
When applying for reimbursement of outpatient medical expenses, the applicant should first deduct the amount allocated to the personal account of medical insurance in this social security year, and then verify the amount to be reimbursed.
I hope the above content can help you. If in doubt, please consult a professional lawyer.
Legal basis:
Article 2 of People's Republic of China (PRC) Social Insurance Law
The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to get material help from the state and society in accordance with the law when they are old, sick, injured, unemployed and have children.
Article 28
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.