Medical insurance center reimbursement need to take what materia

The proceres are as follows:

1. On admission: Patients with medical insurance should go through the social security registration proceres with their ID cards, and then go to the ward for hospitalization

2. When discharged: the doctor arranged the patient to be discharged, and went to the charge office to handle the discharge settlement proceres with the admission registration form and ID card

at present, the reimbursement process has been simplified. Patients do not need to go to the social security center for reimbursement, and can settle accounts directly in the hospital

the so-called hospitalization reimbursement of medical insurance is not that you pay cash in advance and then pay with bills, but that when you are hospitalized in a designated hospital of medical insurance, you issue a medical insurance card to let the unified medical insurance settlement system read the information of the insured and handle the hospitalization number. When you are discharged from the hospital, the medical insurance system will not receive the "part of the reimbursement" - the overall payment part

extended data

reimbursement scope of medical insurance:

1. The reimbursement of medical insurance card is limited to the medical expenses above hospitalization caused by diseases and some accidents in designated hospitals

the reimbursement formula is as follows: (total expenses - threshold expenses - self expense - overspending expenses) * (75 + age * 0.2)%. Under normal circumstances, the actual reimbursement proportion varies from 20% to 60%

self funded drugs are not reimbursable, class B drugs are reimbursable by 80%, bed fee is limited, and some inspection fee and diagnosis and treatment fee according to the regulations are not reimbursable

2. The reimbursement amount of medical insurance card is 4 times of the average salary of local social workers (accumulated value within one year)

3. The money in the medical insurance card can be used to buy medicine in the designated drugstore and pay for outpatient and emergency expenses, but it does not belong to the reimbursement category, because the money in the medical insurance card is the money in the medical insurance indivial account

4. Reimbursement of serious illness insurance

after a serious illness occurs to the insured, the part of indivial's own responsibility that occurs in the designated medical institutions of the city's medical insurance and conforms to the provisions of the city's medical insurance will be included in the payment scope of residents' serious illness insurance, and 50% will be reimbursed by the serious illness insurance fund

that is, the reimbursement amount = the self financing part × 50%

The original of the original charge data sheet, the original of the expense detail sheet, the original of the outpatient medical record, the original of the diagnosis, the emergency hospitalization certificate, the original of the social security card, the original of the ID card (the agent's ID card should also be provided), the original of the bank account (passbook or bank card is OK), Original unit certificate

if the applicant wants to apply for the reimbursement of the second level hospitalization expenses of medical insurance, he needs to meet the following conditions:

1. He has gone through the insurance proceres, paid the medical insurance expenses in full on time, and the insurance time is on the 1st of the next month

2

3. When the insured went to the medical institutions that had been registered, they had incurred hospitalization expenses, which had been paid in advance, and had the corresponding medical expense documents and hospitalization materials

reimbursement process:

first, the applicant needs to go through the reimbursement application proceres, and then submit the relevant application materials required for reimbursement. The place of submission of materials is the medical insurance Department of the social security branch of the Social Security Fund Management Bureau

after receiving the reimbursement application from the applicant, the acceptance Department of the administration will check the application materials provided by the applicant within 5 days from the date of receiving the materials, and decide the final acceptance result

if the application materials are wrong or incomplete, the acceptance department will inform the applicant and inform him to prepare the required materials at one time within 5 days, and correct the wrong contents in the materials

and the applicant should complete the material correction within 5 days from the date of receiving the notification of material correction. If the time limit is exceeded, no correction will be made and the application will be withdrawn

if the materials have been supplemented and corrected within the time limit, the application can be reapplied within the validity period of medical insurance reimbursement

The following information is required for reimbursement:

1. Original ID card or social security card

2. The original diagnosis certificate issued by the doctors of designated medical institutions

3. Outpatient medical records, examination, test results report and other original medical information

4. The original receipt of outpatient charges of medical institutions unified by finance and tax

5. The detailed list of outpatient expenses printed by the hospital computer or the original payer's prescription issued by the doctor

6. Designated drugstores: the original of unified invoice and computer printed list for tax commodity sales,

7. If it is handled on behalf of a person, the original ID card of the agent shall be provided

materials required for instrial injury reimbursement:

Application Form for instrial injury identification in quadruplicate, invalid One original and one of diagnosis certificate and outpatient (inpatient) cases or occupational disease diagnosis certificate; One original and one of the labor contract; A of ID card of the injured person

extended data:

hospitalization:

1. Reimbursement scope: the hospitalization expenses of the insured in the designated hospital or specialized hospital of medical insurance, traditional Chinese medicine hospital and class a hospital selected by indivials

2. Hospitalization starting line: in a natural year, the first hospitalization starting standard is 1300 yuan, and then 650 yuan each time

3. Reimbursement proportion: 90% in the first level hospital, 87% in the second level hospital, and 85% in the third level hospital, with a total reimbursement of 300000 yuan

4. Handling process: please use the "Beijing Medical Insurance Manual" when seeing a doctor. If the unit pays in full, the indivial only needs to pay part of the hospitalization prepayment to go through the hospitalization proceres. The medical expenses incurred should meet the scope of medical insurance. When leaving the hospital, the hospital and the indivial should settle the part of their own expenses, and the reimbursement amount of the overall fund should be settled by the hospital and the district medical insurance center

goes to the 52 level bookstore in the Shanghai Center: the Shanghai flagship store (the highest bookstore in Shanghai) does not need to make an appointment. Strong> but for the large passenger flow, the lobby on the first floor of Shanghai center will be limited. If there are more than 350 people in the bookstore, the building will start warning. Therefore, there will be a special place in the building for people waiting there to line up. The staff of the bookstore are waiting at the elevator entrance. An elevator can take about 18 people. The staff of the bookstore upstairs inform the staff of the elevator queue of the number of people who can go upstairs according to the passenger flow in the store