Xi residents' medical insurance outpatient reimbursement process

In the process of reimbursement of outpatient medical insurance for residents in Xi, residents are first required to receive outpatient treatment in designated medical institutions with medical insurance, and relevant medical bills and medical records are kept. Subsequently, submit an application for reimbursement to the medical insurance department according to the prescribed procedures, and after review, you can enjoy the corresponding medical insurance reimbursement treatment.

First, outpatient treatment and data preparation

In Xi, the first step of outpatient reimbursement for residents' medical insurance is outpatient treatment in designated medical institutions. These designated medical institutions include public hospitals, community health service centers and private medical institutions that meet the requirements. When receiving outpatient treatment, residents should keep relevant medical bills and medical records, including outpatient medical records, prescriptions and inspection reports.

Second, submit an application for reimbursement

After completing outpatient treatment, residents need to submit an application for reimbursement to the medical insurance department in accordance with the prescribed procedures. The materials to be provided at the time of application include: my valid identity certificate, medical insurance card, medical expense list, medical records, etc. The application method can be online or offline, which can be selected according to the regulations of the local medical insurance department.

Online applications are generally made through the official website of the medical insurance department or the mobile app. Residents need to fill in relevant information according to the prompts and upload the required materials. Offline applications require residents to go to the window of the medical insurance department in person and submit paper application materials.

Three. Audit and reimbursement

The medical insurance department will conduct a strict review after receiving the application for reimbursement from residents. The contents of the audit include the authenticity and completeness of the application materials and whether they conform to the provisions of the medical insurance policy. After approval, the medical insurance department will directly pay the medical expenses that should be reimbursed to residents or medical institutions according to the prescribed reimbursement ratio and scope.

Residents can check the reimbursement progress and results through the medical insurance department official website or the mobile APP. If the audit fails, the medical insurance department will inform the reason and prompt the residents to supplement the materials or re-apply.

To sum up:

Xi residents' medical insurance outpatient reimbursement process requires residents to receive outpatient treatment in designated medical institutions for medical insurance and keep relevant bills and medical records, and then submit reimbursement applications to the medical insurance department. Upon examination, eligible residents can enjoy the corresponding medical insurance reimbursement treatment. The whole process pays attention to standardization and convenience, aiming at protecting the legitimate rights and interests of residents and reducing the burden of medical expenses.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 28 provides that:

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Xi Measures for Basic Medical Insurance for Urban Residents

Article 12 stipulates:

The medical expenses of the insured residents in the outpatient treatment of special diseases in designated medical institutions shall be paid by the outpatient co-ordination fund at a rate of 50%.