Is emergency reimbursement going to social security center or me

1.

1、 First of all, confirm the conditions of emergency reimbursement:

(1) the patients who died in the on-site first aid or on the way of transfer, in the emergency room and in hospital

(2) patients who were transferred to the hospital after on-site first aid and met the following emergency diseases were reimbursed. The reimbursement scope of emergency medical insurance is: acute cerebral hemorrhage, acute massive cerebral infarction, acute heart failure, acute myocardial infarction, serious arrhythmia, hypertensive crisis, pulmonary embolism, pneumothorax, acute shock, coma, persistent state of asthma, status epilepticus, massive hemoptysis, massive hemorrhage of upper digestive tract, uterine functional hemorrhage, etc., acute abdomen of emergency operation, emergency treatment and emergency treatment Severe acute poisoning and moderate burn. Other diseases will not be reimbursed

(3) patients who were transferred to the hospital after on-site first aid and failed to be hospitalized will not be reimbursed

Second, go through the proceres of hospitalization:

1. Go to the first floor of the inpatient department to go through the proceres of hospitalization after holding the hospitalization certificate issued by the doctor

2. Show the patient's ID card and prepare the amount of advance payment. Take the ID card and go through the registration procere in time after entering the ward

All levels of medical insurance patients show medical record card, magnetic card or letter of introction when they go through admission proceres. If you don't have a medical insurance card, you can be hospitalized at your own expense first, but you must go through the change proceres within 3 days with the hospitalization certificate and the certificate mentioned above

4. After going through the hospitalization proceres, they can go to the corresponding ward for hospitalization with the hospitalization certificate and the first page of the medical record. Carefully check the name and amount on the receipt of advance payment, and keep the receipt properly (it must be used as the voucher when making up the hospitalization expenses and handling the discharge proceres)

Third, taking the social medical insurance measures of Shenzhen as an example, Article 56 stipulates that the payment proportion of the insured persons in the three grades of basic medical insurance who are hospitalized in the city's first-class hospitals, second-class hospitals, third-class hospitals and hospitals outside the city are 85%, 80%, 75% and 70% respectively. 90% of the inpatient medical expenses incurred in emergency rescue in non settlement hospitals e to work or business trip shall be paid according to the inpatient payment standard of the visiting hospital

Fourth, consult the local social and Human Security Bureau

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extended information:

the medical expenses paid in cash can be directly reimbursed in the following circumstances:

< P > 1. The medical expenses incurred by the insured in the emergency department of the city's medical insurance designated hospitals without medical certificate or referral proceres

2. The medical expenses incurred by the insured ring the period of enjoying medical insurance benefits e to the temporary absence of medical certificate

3. The medical expenses of emergency and emergency inpatients in hospitals of other provinces and cities

4. Medical expenses in accordance with the provisions occurred in other provinces and cities after the insured went through the relevant proceres

2. I don't know if you are an indivial or a unit going to the medical insurance center for reimbursement. The indivial saves up the bill and so on to go to the unit to look for the handling person to handle
the reimbursement steps of the unit to the medical insurance center are as follows:
1. First of all, collect all the documents, case books, diagnosis certificates, etc. The case diagnosis certificate, etc. shall be copied and stamped with official seal
2. If it is a general emergency, the "five insurances in one" software should be entered as a general outpatient. If it is emergency observation, enter it by emergency observation. Emergency observation needs the hospital's observation certificate
3. Documents are divided into upload number and no upload number, which are entered separately to generate reports and offer files. It should also be stamped with the official seal
4. In case of trauma, prepare an injury description and affix official seal at the same time
5. Prepare all the above materials, and have the social security card of the reimbursement person to go to the district medical insurance center or social security center for reimbursement
6. After reimbursement, get the reimbursement details in about 10 days
7. After about two weeks, the money will be transferred to the company's collection account.

3. Medical insurance can be reimbursed for emergency, not hospitalization can also be reimbursed, as long as there is a medical bill in line with the provisions< The reimbursement ratio of medical insurance:

1

2. Settlement ratio: 50% for the part of dispatched personnel over 2000 yuan ring the contract period, and 50% for indivial payment; In a year, the maximum amount of outpatient and emergency reimbursement for dispatched personnel is 20000 yuan

3. The insured should take good care of the outpatient medical documents (including the receipt of the part below the large amount, the prescription, etc.) as the medical expense reimbursement voucher< 4. For outpatient treatment of three kinds of special diseases: when the insured person is suffering from radiotherapy and chemotherapy for malignant tumor, renal dialysis and anti rejection drugs after renal transplantation, the second and third level designated hospitals of the insured person shall issue the "disease diagnosis certificate" and fill in the application and approval form for special diseases of medical insurance, and report to the district medical insurance center for approval and filing. The outpatient treatment and medication for these three special diseases are limited to the designated hospitals approved for treatment, and cannot be purchased from the designated retail pharmacies. If the medical expenses meet the specified scope of outpatient special diseases, settlement shall be made with reference to hospitalization.

4.

Social medical insurance reimbursement is after discharge or transfer

1. Settlement proceres for inpatients and outpatients with special diseases:

2. Designated medical institutions shall report the expense settlement sheet, inpatient settlement sheet and relevant information of discharged patients in the previous month to the medical insurance agency before the 10th day of each month, which will be used as the basis for monthly budget and year-end final accounts after being reviewed by the medical insurance agency

3. The medical insurance agencies pre allocated the overall expenses of hospitalization and outpatient treatment of special diseases in the previous month

4. The insured with special diseases should go to a designated medical institution designated by the labor and social security department for medical treatment and purchase, and the medical expenses incurred should be directly recorded and settled immediately

extended data:

Social Security reimbursement handling process:

1. Application: the handling personnel of the unit shall report the above materials to the social security center

2. Acceptance: the work injury identification department shall review the application within 15 days after receiving the application, and accept the application that meets the requirements. If the application materials are not complete, the unit operator shall be informed to complete the materials within 30 days

3. Identification: within 60 days (another 30 days under special circumstances) after the examination, the instrial injury identification conclusion notice shall be made and the unit operator shall be informed; for those who do not meet the identification conditions, the unit operator shall be informed; for those who are identified as instrial injury, the instrial injury certificate shall be issued

4. Appraisal: when the period of work stoppage and salary retention has expired or the injury is basically stable after treatment, the applicant shall submit the appraisal of labor ability to the labor ability appraisal committee to assess the disability level

5. Benefits of work-related injury insurance: if it meets the conditions for enjoying the benefits of work-related injury insurance, the agent of the unit applies to the social security center for the benefits audit. According to the approved benefits, the social security center will pay the benefits to the work-related injury workers within the specified time

5. When you see an emergency, you must first go through the deposit proceres. Otherwise, it's not hospitalization. No hospitalization, no reimbursement. Reimbursement can only be made after discharge.

6.

Medical insurance reimbursement flow chart:
medical insurance reimbursement instructions for purchasing medicine:
insured personnel can purchase medicine with medical insurance card in all designated medical institutions and designated retail pharmacies, and their medical expenses can be settled directly with the card. When purchasing medicine, it is not included in the social planning, but is paid by personal account. If the personal account fund is used up, it can be paid in cash
outpatient medical insurance reimbursement process and precautions:
the following information should be carried when reimbursement: 1. Original ID card or social security card; 2. The original of the disease diagnosis certificate issued by the specialist of the designated medical institution; 3. The original of outpatient medical records, inspection, test results report and other medical information; 4. The original receipt of outpatient charges of the unified financial and tax medical institutions; 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: unified invoice of tax commodity sales and original computer printed list; 7. If it is handled on behalf of a person, the original ID card of the agent shall be provided
bring all the above information to the relevant departments of the local social security center to apply for processing. After verification, if the information is complete and meets the conditions, it can be processed immediately. When applying for reimbursement of outpatient medical expenses, the applicant shall first dect the amount transferred into the personal account of medical insurance in the current social security year, and then verify the amount to be reimbursed
hospitalization medical insurance reimbursement process and precautions:
1. When admission or discharge, you must go to the medical insurance management window of each designated medical institution with the medical insurance IC card to register in and out of the hospital. When hospitalized, the indivial pays the medical expense deposit in advance, after leaving the hospital, more still less make up. Medical expenses incurred before hospitalization registration are not included in the payment scope of basic medical insurance. If the emergency inpatient fails to go through the registration proceres in time, he should go to the medical insurance management window with the emergency certificate on the next day after admission to make up the hospitalization proceres (postponed in case of holidays), and the medical expenses beyond the time limit shall be borne by himself
2. The starting line of the overall planning fund for the insured after hospitalization: the starting line varies from place to place, generally 10% of the annual average salary of the employees in the city in the previous year. In a basic medical insurance settlement year, the accumulated medical expenses of multiple hospitalization are calculated
3. If the insured person needs to be transferred to another hospital or hospital e to his or her illness, he or she should be diagnosed by the deputy chief physician or department director of the designated medical institution at or above the third level, and then submit the application form to the medical insurance management department of the designated medical institution for approval
the transfer is limited to the provincial special hospitals. The expenses should be paid in advance, and the reimbursement standard should be 10% at first, and then the reimbursement amount should be calculated according to the local regulations
4. When a designated medical institution is discharged from hospital, each designated medical institution will calculate the reimbursement amount of medical insurance and the amount that an indivial should pay according to relevant policies. The reimbursement amount is settled by the designated medical institution and the urban social insurance agency, and the amount that an indivial should pay is settled by the designated medical institution and the insured person
the reimbursement time of each kind of medical insurance is different. It is suggested to log in to the website of the local human resources and Social Security Bureau to check the relevant policies and regulations, or call 12333 to inquire about the reimbursement time of local medical insurance

How to buy insurance, which is better, hand in hand to teach you to avoid these "pits" of insurance

7.

The medical expenses incurred by the invalid death of the insured in the emergency rescue, the medical expenses incurred ring the period of emergency observation to hospitalization observation, and the medical expenses of the insured in the emergency treatment of the approved diseases of the specified diseases in the outpatient department are not included in the payment scope of the general outpatient department

if the insured person's emergency expenses occurred in the designated medical insurance institutions, they will be included in the general outpatient coordination settlement and be reimbursed after being audited by the medical insurance management department of the designated medical institutions. However, the pooling fund will not be paid for the emergency medical expenses incurred by the insured in the general outpatient coordination designated medical institutions of non-medical insurance designated institutions

First, emergency settlement proceres:

the medical expenses incurred by the insured who are hospitalized in the city's non designated medical institutions and remote medical institutions e to emergency rescue shall be paid by the indivial or unit in advance. After the end of emergency rescue, the medical expenses incurred shall be paid by the hospital's emergency medical records, examination, laboratory report, invoice and other documents Detailed list of medical charges until the medical insurance agencies handle reimbursement proceres according to the regulations. 2. Medical insurance regulations:

1. The medical expenses of outpatient treatment, medicine purchase and hospitalization of the insured are paid by the indivial account, and the insufficient part is paid by the indivial account. Therefore, the general outpatient medical expenses of the insured are directly collected by the hospital from the medical insurance personal account in their social security card, and the insufficient part is paid by themselves in cash

2. If the insured have 12 kinds of special diseases, such as coronary heart disease, hypertension, diabetes, malignant tumor, psychosis, liver cirrhosis, renal dialysis, after kidney transplantation, Parkinson's disease, rheumatoid arthritis, systemic lupus erythematosus, breast cancer, endocrine outpatient treatment, they can apply to the municipal Medical Insurance Center for special disease identification and apply for "special disease outpatient medical card", Enjoy outpatient treatment for special diseases

3. The expenses of patients with special diseases in outpatient treatment of special diseases can be settled with designated hospitals in real time. When settling, only the part of medical expenses that the indivial pays according to the policy is paid, and the rest is borne by medical insurance

4. In case of emergency, the insured persons who are sent to the hospital for emergency treatment and stay in hospital can directly settle the medical expenses in the hospital with the social security card; For those who are hospitalized in non designated public medical institutions in the city or other places, the medical insurance center of the city shall be informed within 3 days (postponed on holidays), and the medical expenses incurred in the city shall be settled in the medical insurance center within one month after discharge, which shall be settled according to the hospitalization standard of secondary hospitals; For medical expenses incurred in other places, the indivial shall pay 10% first, and the rest shall be settled according to the inpatient standard of the city's tertiary hospitals

5. The insured who received general treatment instead of rescue in emergency were not included in the reimbursement scope. In addition, emergency observation rather than hospitalization can not be reimbursed

8.

It's reimbursable

first of all, the reimbursement is not decided by the medical insurance card. As long as you pay the social security expenses, you will establish a social security account and enjoy the relevant rights and interests of social security. Therefore, no matter whether you have a medical insurance card or not, you can make reimbursement, but it will be a little troublesome to make reimbursement without a medical insurance card

there is no social security card, no temporary card, only social security, this kind of situation is more troublesome. In this case, in the hospital registration, pay to the toll gate, the cost first paid by themselves, and then by the unit or indivial to the insured Social Security Bureau reimbursement. After treatment, take the hospital invoice, statement and other proof materials to the local social security center for reimbursement

< H2 > extended data

the indivial accounts on the medical insurance card of the insured in the unit are not all paid by themselves; Since the last year, the medical insurance card of flexible employment personnel also has a personal account of 15 yuan per month, which can be used to pay for outpatient expenses, which is equivalent to outpatient reimbursement (the insured belongs to civil servants or units, except for other reimbursement policies)

when hospitalized with medical insurance, show the medical insurance card, read the card into the medical insurance system, pay the deposit (generally threshold fee), and enter the expenses incurred into the system. The system automatically classifies them into self funded, class A, class B, etc., and class B pays 10% first, and then enters the basic medical care

according to the number of hospitalizations (more than once, the threshold fee is halved) and the level of hospital (different threshold fee and different proportion of overall planning), the computer calculates how much the hospital should pay and how much the hospital will settle with the medical insurance center of social security