Emergency to the community service center reimbursement

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. 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.

3.

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

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4. The expenses in line with the provisions of basic medical insurance for urban employees within one year of outpatient and emergency treatment of on-the-job employees shall be paid by their personal medical accounts in the current year. The insufficient part shall be paid by indivials to the standard of outpatient and emergency self payment, and the excessive part shall be paid by additional funds in a certain proportion. The details are as follows:
1. For employees under 44 years old, the standard of self payment for outpatient and emergency department is 1500 yuan. For outpatient and emergency department in first, second and third level medical institutions, 65%, 60% and 50% of them are paid by additional fund respectively
2. For employees over 45 years old, the self payment standard for outpatient and emergency department is 1500 yuan. For outpatient and emergency department in first, second and third level medical institutions, 75%, 70% and 60% of them are paid by additional fund respectively
3. For the former "secondary one" staff (born before December 31, 1955 and working before December 31, 2000), the standard of outpatient and emergency self financing section is 1500 yuan, and the part of medical expenses exceeding the standard of outpatient and emergency self financing section is 75% paid by the additional fund in the outpatient and emergency department of the first-class medical institution; In the case of outpatient and emergency treatment in secondary and tertiary medical institutions, the original provisions shall be followed, that is, 70% shall be paid by the additional fund.

5.

Emergency expenses can be reimbursed
for outpatient and emergency expenses incurred by the insured, the social security report form of the advance outpatient receipt shall be stamped with the seal of "indivial full advance payment", and then it shall be reported to the social security sub center through the employer
if the patient is transferred to the hospital for further treatment after emergency treatment, the emergency outpatient expenses and hospitalization expenses will be reimbursed in real time through the medical insurance network. At the same time, the indivial will only bear the standard of one-off payment

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6. The emergency department should be able to be reimbursed manually, but it should be stamped with the official seal of the emergency department. In addition: the proportion of medical reimbursement of insured employees, the starting payment standard of medical treatment category, the proportion of real-time reimbursement, the proportion of reimbursement of basic medical insurance co-ordination fund, the proportion of reimbursement of large mutual funds ≤ 30000 ≤ 40000 ＞ 40000 years, the accumulated maximum amount of reimbursement, the proportion of reimbursement of basic medical insurance co-ordination fund ＞ 100000 yuan, and the accumulated maximum amount of reimbursement, the outpatient clinic, is 1800 yuan, 70% / / / Community 90% / / / / / initial hospitalization: 1300 yuan ≥ 2 times: 650 yuan, level 3 85% 90% 95% 100000 yuan, level 2 87% 92% 97% level 1 90% 95% 97% medical reimbursement proportion of insured employees, starting payment standard, real-time reimbursement proportion, basic medical insurance co-ordination fund reimbursement proportion, large mutual fund reimbursement proportion ≤ 30000 ≤ 40000 > 40000 years cumulative maximum reimbursement amount Basic medical insurance co-ordination fund reimbursement of more than 100000 yuan, the proportion of annual cumulative maximum reimbursement amount: outpatient service 1800 yuan 70% / / / / / community 90% / / / hospitalization first time: 1300 yuan ≥ 2 times: 650 yuan, tertiary hospital 85% 90% 95% 100000 yuan, secondary hospital 87% 92% 97% primary hospital 90% 95% 97% see more answers & gt& gt;

7. 1. Take your invoice to the hospital and ask them to stamp the emergency seal on you. For details, ask the doctor in the emergency department
2. Consult the medical insurance office of your unit or the medical insurance office of your hospital. It's better to consult the medical insurance office about the next reimbursement procere
3. In general, take the stamped invoice, medical record, diagnosis certificate and the corresponding list of the invoice to the municipal medical insurance office for reimbursement!

8. The emergency receipt is stamped with the emergency seal in the hospital, and can be reimbursed manually without the blueprint. In the manual reimbursement in the software, click medical expense entry to enter the general outpatient expense entry. Enter the ID number and click on the query, click add, enter the designated medical institution (or emergency hospital) according to the bill, the date of the fee, the number of documents, the total cost and total sum, etc., then click Save to generate the audit form (if there are multiple documents to repeat operation). Then exit the general outpatient expense entry, click data offer to enter the general outpatient reimbursement offer file, click query to print and generate the Beijing Basic Medical Insurance Manual reimbursement expense details, click offer to save the data in USB flash disk and submit it to the medical insurance center. When you go, take all the documents, the generated reports and USB flash disk, and the official seal with you!

9. In general, the expenses of emergency department are incurred in outpatient department, which can not be reimbursed for rural cooperative medical care and medical insurance, but can be reimbursed with regular medical invoice for other insurance.

10.

Emergency expenses are reimbursable. According to Article 28 of the social insurance law of the people's Republic of China, "the medical expenses in accordance with the drug catalogue, diagnosis and treatment items, medical service facilities and standards of basic medical insurance, as well as emergency and rescue, shall be paid from the basic medical insurance fund in accordance with the state regulations."

the following two types of emergency medical expenses can be applied for reimbursement: one is the medical expenses of the insured in Shanghai ring the period of reporting loss or loss of medical insurance card or social security card, the other is the medical expenses of the insured in other provinces and cities e to pre hospital emergency in Shanghai; The second type is outpatient and emergency medical expenses, hospital observation in emergency observation room and inpatient medical expenses of the insured in other provinces and cities

extended data:

after going to the medical insurance, if they are on-the-job employees, after going to the outpatient and emergency department of the hospital, the medical expenses above 1800 yuan can be reimbursed, and the proportion of reimbursement is 50%. For retirees under the age of 70, expenses of more than 1300 yuan can be reimbursed, and the proportion of reimbursement is 70%. For retirees over the age of 70, 80% of the expenses above 1300 yuan can be reimbursed

No matter what kind of people, the maximum amount of outpatient and emergency medical expenses is 20000 yuan. For example, if you are an on-the-job employee and spend 2500 yuan to see a doctor in the outpatient department, the part of 700 yuan can be reimbursed by 50%, that is 350 yuan