First, how to reimburse medical insurance after returning to your hometown after resettlement?
Reimbursement of medical expenses in different places:
1, medical expenses for hospitalization in different places or outpatient medical expenses for special diseases have been handled;
2, the hospitalization expenses assigned by the unit to work abroad for a long time;
3, visiting relatives and friends, going out for private emergencies must be hospitalized;
4. Medical expenses for hospitalization of college students at their place of residence or during their internship;
5, have the right to refer to the designated hospitals identified by the city, because of medical technology and equipment conditions need to be transferred to different places for medical treatment.
Reimbursement materials:
1, ID card, medical insurance manual;
2. Bank passbook/UnionPay card or medical insurance personal account card;
3. Stamp the official seal of the hospital, the original bill of effective medical expenses, the summary list of medical expenses, the diagnosis certificate/discharge summary of discharged diseases, and the hospital grade certificate;
4, long-term doctor's advice, temporary doctor's advice (below the county level district, township, street hospitals, factories and mines hospital hospitalization);
5. Admission medical records/emergency medical records (going out for emergency hospitalization);
6, referral approval form (authorized hospitals for referral procedures);
7, college students' holiday illness declaration form (college students' holiday in the residence or internship unit during the internship);
8. Admission records, emergency medical records, and supporting materials (for those hospitalized due to accidental injuries, supporting materials refer to detailed records of injuries);
9 emergency observation medical records (uninterrupted emergency rescue medical expenses within 72 hours before hospitalization);
10, emergency observation medical record, death certificate, and family relationship certificate (medical expenses for death due to continuous emergency rescue).
Reimbursement process:
1. The insured person/unit submits the reimbursement materials to each business processing window every working day morning;
2, the staff to accept the information, and review the information;
3, after the audit is correct, according to the reimbursement policy, directly transfer to the insured person's medical insurance personal account card or Changsha bank account;
4. The insured person swipes the card at any bank outlet or UnionPay teller machine for verification or withdrawal.
Two, medical fault bear the consequences of medical insurance
Without great consequences, medical accidents can be reimbursed by medical insurance.
First of all, you need to apply for reimbursement with the invoice of hospitalization, and you also need some hospitalization manuals to prove that you need to bring the following materials: if you don't need to pay with social security card in emergency, you need to take the hospitalization receipt, prescription and medical certificate to the social security bureau for reimbursement. If the medical expenses incurred meet the scope of reimbursement, you can bring relevant materials (outpatient medical records, invoices, social security cards, ID cards, etc.). ) go to the local community health service center for reimbursement according to the process.
The scope of medical insurance can not be reimbursed:
1, did not see a doctor in a designated hospital.
Medical insurance cards can only be used in designated hospitals, and medical insurance will be reimbursed. Medical insurance will not be reimbursed for not seeing a doctor in a designated medical institution. Moreover, the higher the level of hospital treatment, the lower the reimbursement ratio.
2. Exceeding the reimbursement limit
After the unification of medical insurance for urban and rural residents, the real-time reimbursement of medical expenses has been realized, and the reimbursement ratio is still the same as before, but the accumulated reimbursement amount for one year is limited.
3. Special medical care
(1) Medical expenses for traffic accidents or work-related injuries due to personal reasons will not be reimbursed.
(2) Medical expenses caused by drunk driving, drug abuse, theft and other reasons will not be reimbursed by medical insurance.
(3) Medical expenses such as abortion and abortion caused by personal reasons will not be reimbursed by medical insurance.
(4) Medical expenses incurred due to plastic surgery, beauty, weight loss and other reasons will not be reimbursed by medical insurance.
4. Special treatment
Some medical projects will have special medical project funds, such as children's vaccines, and some related institutions will vaccinate children for free. If parents take their children for vaccination at their own expense, it is not within the scope of medical insurance reimbursement, and medical insurance will not be reimbursed.
Three, the occurrence of medical accidents in the following circumstances need to bear criminal responsibility.
According to the provisions of Articles 23 to 25 of the Measures for Handling Medical Accidents, the criminal responsibility of the person directly responsible shall be investigated by judicial organs according to law in the following three cases:
1. After a medical accident or incident, medical records and related materials are lost, altered, concealed, forged or destroyed, and the circumstances are serious enough to constitute a crime. According to the principle of a legally prescribed punishment for a crime, only if it constitutes a crime can there be related conviction, sentencing and punishment. Destroying or concealing evidence may constitute crimes such as helping to destroy or falsify evidence according to the law.
2. If the medical staff is extremely irresponsible, resulting in the death of the patient, and the circumstances are bad enough to constitute a crime, this crime is the crime of medical malpractice.
3. Disrupting the normal medical work order under the pretext of a medical accident in a medical unit, and the circumstances are serious enough to constitute a crime. According to this situation, the crimes are the crime of stirring up trouble in Article 293 of the Criminal Law and the crime of gathering people to disturb social order in Article 290 1.
The criminal law amendment adds the crime of medical liability accident. According to the criminal law, medical personnel who are seriously irresponsible and cause the death of patients or seriously damage the health of patients shall be sentenced to fixed-term imprisonment of not more than three years or criminal detention. The object of this crime is qualified hospital medical staff and nursing staff, and their medical faults have caused physical damage to patients, and there is a causal relationship.
Medical insurance can be reimbursed when you go back to your hometown for medical treatment after resettlement, and hospitalization expenses for resettlement or outpatient medical expenses for special diseases can be reimbursed for college students' hospitalization expenses in their residence or practice place during holidays.