Part 1: The whole process of medical insurance reimbursement
1) Process name: manual reimbursement of hospitalization expenses for cerebral infarction.
2) Reimbursement location: Medical Insurance ** Management Center.
3) Acceptance criteria.
Service objects: basic medical insurance for employees, basic medical insurance for urban and rural residents, non-online card settlement, outpatient (emergency) hospitalization or medical expenses due to other special circumstances and eligible for treatment of insured persons
Acceptance conditions: basic medical insurance for employees, basic medical insurance for urban and rural residents, non-online card settlement, outpatient (emergency) hospitalization or medical expenses due to other special circumstances and eligible for treatment of insured persons.
4) Handling materials.
Medical insurance electronic voucher or valid ID or social security card.
Hospital bills.
List of hospitalization expenses.
Certificate of diagnosis or discharge summary.
Remarks: 1) For hospitalization of cerebral infarction caused by accidental injury, relevant supporting materials issued by the public security department such as traffic accident identification, court judgment, mediation agreement and other relevant certification materials should be provided, and the personal commitment letter should be filled in first if it cannot be provided
2) Emergency diagnosis certificate is required for cerebral infarction
3) Purchased drugs need to provide a copy of the original purchase invoice, inpatient doctor's order or purchased drug prescription and the "Hospitalization Inspection** or Designated Pharmacy Drug Purchase List".
5. My bank account information.
5) Handling process.
1.The sponsor should bring the relevant materials to the service window of the medical insurance agency in the place where the applicant participates
2.The staff will review whether the materials meet the handling conditions, and if the materials meet the handling conditions, they will be accepted immediately, and if the materials do not meet the conditions, they will be notified at one time
3.After the handling agency reviews and reviews the relevant expenses (verifies the medical expenses that need to be verified), the handling agency completes the payment and feeds back the results.
At the same time, it can also be handled online or in the palm of your hand
1.The sponsor can submit the required materials for reimbursement online or in the palm of his hand according to the prompts
2.The staff will conduct a pre-examination of whether the materials meet the conditions, and if the pre-examination is passed, the insured shall be notified to mail the materials and inform the mailing address, and if the materials do not meet the requirements, a one-time notification shall be in place;
3.After the handling agency reviews and reviews the relevant expenses (verifies the medical expenses that need to be verified), the handling agency completes the payment and feeds back the results.
6) Time limit for processing.
10 working days, no more than 20 working days in special circumstances.
Part II: Precautions for Medical Insurance Reimbursement for Hospitalization for Cerebral Infarction:
1. The reimbursement method of cerebral infarction medical insurance is generally divided into two types: expense compensation and fixed payment. Expense compensation means that the insurance company reimburses the insured according to the actual medical expenses incurred, and generally needs to provide relevant medical invoices, expense lists and other materials. Fixed payment means that the insurance company pays according to the amount agreed in the insurance contract, and there is no need to provide specific medical expense details.
2. The reimbursement amount of medical insurance for cerebral infarction varies depending on the insurance contract. Generally speaking, the reimbursement amount of cerebral infarction medical insurance includes two parts: one is the reimbursement of medical expenses, and the other is the payment of insurance money.
3. The reimbursement of medical expenses is generally calculated according to the actual expenses incurred, and the specific reimbursement ratio and upper limit are determined according to the agreement of the insurance contract. Some insurance companies will set a reimbursement rate, such as 80% or 90%, which means that the insurance company will reimburse the medical expenses according to the agreed percentage. At the same time, the insurance contract will also stipulate the upper limit of reimbursement for medical expenses, that is, the maximum amount that the insurance company will pay for medical expenses.
Part III: List of major diseases in our province for serious illness assistance:
1. Malignant tumors, including radiotherapy, chemotherapy, interventional**, biologically targeted drugs**, endocrine**;Chronic renal failure, including hemodialysis, peritoneal dialysis, non-dialysis**;Hemophilia, anti-rejection**, aplastic anemia, systemic lupus erythematosus, tuberculosis, type I diabetes mellitus, autism, growth hormone deficiency in children, etc. Refractory nephrotic syndrome, thalassemia major, chronic active hepatitis, cirrhosis decompensation, Wilson's disease.
The minimum payment standard for these diseases is 1,500 yuan, and the settlement and payment ratio is based on the hospitalization standard in principle. The maximum payment limit for medical expenses within the scope of a co-ordinated annual policy is $250,000.
2. For severe mental disorders, including mental disorders, affective disorders, paranoid psychosis, bipolar disorders, mental disorders caused by epilepsy, mental retardation with affective disorders, and other severe mental disorders.
The minimum payment standard, settlement method (payment ratio), and the maximum payment limit of medical expenses within the scope of a co-ordinated annual policy are consistent with those of employee medical insurance.
3. Consolidation period of mental illness: the minimum payment standard, settlement method, and the maximum payment limit of medical expenses within the scope of a co-ordinated annual policy stipulate that 280 yuan per person per month is paid in full by the medical insurance**, and individuals do not need to pay;If the conditions for payment according to the type of disease are not met, the payment can be made according to the project, and there is no minimum payment standard.
Part 4: Each province has different regulations on the reimbursement standards for cerebral infarction, and the reimbursement process and proportion are different. For details, please consult your local medical insurance center or medical insurance bureau.
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