Mandatory
The insurance reimbursement process is as follows:
1. Report the case to the insurance company in a timely manner and keep the evidence and documents;
< p>2. Prepare documents for claim settlement. Usually, once the case is reported, the insurance company will arrange for a special person to contact the individual to assist with the settlement of the claim and inform the customer of the claim settlement process, the requirements for settlement of the claim. claim settlement information and delivery address for paper documents;3. Collect Complete the claim information and submit it to the insurance company
4. Wait for the insurance company to review them. . Generally, if it is a small matter, they will respond within 3 business days. If it is an ordinary file, it will take 5-7 daysrs working hours, if it is an important file, it will not exceed 1 month. /p>
5. Just wait for the claim payment to arrive.
Work accident insurance means that when a worker suffers an industrial accident or occupational disease at work or under specified special circumstances, resulting in temporary or permanent loss of ability to work or death, the worker or his survivors receive state compensation and a social insurance system through which society receives material assistance.
Answered 03/30/2022
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Can someone teach me the insurance reimbursement process
Instructions for reimbursement of social security Action to compensate employees' medical costs, maternity costs and the costs of treating workplace accidents on a pro rata basis through social insurance. Social security reimbursement mainly includes three components: reimbursement of maternity insurance and reimbursement of work accident insurance. Social health insurance reimbursement arrangements vary from place to place. Social security reimbursement procedure: Make an appointment firstd in a public hospital designated by health insurance for hospitalization → Within three working days following hospitalization, you must register and submit your file to the hospital health insurance fund → Upon your discharge, go to the health insurance office to issue a hospitalization request form, a hospitalization invoice, a detailed list and a medical file. If it is a traumatic injury, you must also go to the hospital health insurance office to fill out the form. The injury form must be stamped with the official seal of the hospital where you are staying and the official seal of the insured unit, write a description of the situation of each person, as well as a description or attestation of the situation of the insured unit → go to the second floor office of the Social Work Office and social security for reimbursement. Medical insurance for rUrban residents require originals of the above documents upon reimbursement. If you need to reimburse commercial insurance, please make a copy of all of the above documents and stamp them with the hospital seal for commercial insurance purposes. If you have the new Rural Cooperative Medical Care and Urban Residents' Medical Insurance, you cannot apply for them at the same time. You can only request both. If you have commercial insurance, you must first purchase medical insurance for urban residents, then apply for commercial insurance, if you purchase medical insurance for urban residents first, the medical insurance for urban residents will no longer provide refunds; 2. Health insurance reimbursement process for different reasons for hospitalization: 1. Illness and hospitalization: Within three days following hospitalization, go to thehospital health insurance fund with valid documents such as health insurance card or ID card, household register, etc. via the procedures of the health insurance network. When you leave, go directly to the hospital health insurance office. Complete the payment procedures. 2. Hospitalization for trauma: Within three days following hospitalization, go to the hospital health insurance fund with valid documents such as health insurance card, identity card, booklet cleaning, etc. to follow the procedures of the health insurance network. the inspection department of the municipal (district) health insurance fund, if it meets the health insurance reimbursement rules, When you are discharged, go directly to the hospital health insurance fund to carry out settlement procedures if the investigation is not clear or; if you have any objections, after yourWhen leaving the hospital, bring all documents such as medical records, invoices, payment forms, copies of your CCB bank passbook, etc. to the municipal health insurance fund for investigation, then go to town. The Residents' Medical Insurance Management Section will ensure reimbursement. 3. Ambulatory accidental injury occurs: after treatment, take all outpatient medical records, invoices, copies of your CCB bank book and other documents to the municipal health insurance office for investigation, and then go to the management section of urban residents' health insurance for reimbursement. Further reading: How to buy insurance, which one is best, and step-by-step instructions for avoiding these insurance pitfalls
ABC Insurance Network
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Medical process of reimbursement by the insurance company< /p>
Health insurance This means that under national law, health insurance premiums of basis must be paid in full and on time by individual employers and employees,in accordance with the principle of compulsory social insurance. If payment is not made in full and on time, the basic health insurance fund does not cover medical costs, regardless of the personal account. Outpatient Health Insurance Reimbursement Process and Precautions: You must bring the following when making reimbursementDocuments: 1. Original ID card or social security card; 2. Original disease diagnosis certificate issued by a specialist of a designated medical institution; 3. Original medical records, reports of examinations, test results and other medical information; taxation Original receipt for outpatient charges from a medical facility 5. Detailed list of outpatient charges printed by the hospital computer or the original payer of the prescription issued by the physician 6. Designated pharmacies: original consolidated sales invoice for tax goods and listcomputer printed 7; . If this is done in someone else's name, the agent's original ID card is required. Bring all the above information to the relevant departments of the local social security center to apply. After review, if the information is complete and meets the conditions, it can be processed immediately. When the applicant applies for reimbursement of outpatient medical expenses, the amount transferred to the personal health insurance account in the current social security year will first be deducted, and then the reimbursement amount will be determined. Hospital health insurance reimbursement process and precautions: 1. When you are admitted or discharged, you should take your medical insurance IC card to the medical insurance management window of each designated medical institution to complete the admission and discharge registration procedures. When you are hospitalizedtalized, you must pay a medical expense deposit in advance and you will have to make up the excess after you are discharged from the hospital. Medical expenses incurred before hospitalization registration procedures are not included in the payment scope of basic health insurance. If you do not complete the hospitalization registration procedures on time due to emergency hospitalization, you must go to the health insurance management counter with the emergency certificate the day after your admission to finalize the hospitalization procedures (if it is postponed during the holidays), possibly medical costs exceeding the deadline will be your responsibility. 2. The minimum payment line for the overall fund after the insured's hospitalization: The standard for the minimum payment line varies from place to place. It is generally 10% of the average annual salary of city employees from the previous year. One yearborn from basic health insurance regulations, medical costs for multiple hospitalizations are calculated. 3. If the insured person needs to be transferred or transferred to another hospital due to his or her condition, he or she must be diagnosed by the deputy chief physician or department director of a designated medical institution above level 3 and must then be addressed to him. (hospital). The insurance management department will review and accept it, then submit it to the municipal (district) social security agency for approval before going through the referral (hospital) procedures. Transfers are limited to provincial hospitals and fees must be paid in advance by the patient. The refund standard should first be 10%, then the refundable amount is calculated according to local regulations. 4. Upon leaving a designated medical establishment, each designated medical establishment will calculate the amount of insurance reimbursementmedical ransom and the amount the individual must pay out of pocket in accordance with the relevant policies. The reimbursement amount will be settled by the designated medical institution and. the urban social insurance agency, and the individual will have to pay out of pocket. The amount will be paid by the designated medical institutions and the insured persons themselves. Further reading: How to buy insurance, which one is best, and a step-by-step guide to avoiding these insurance "pitfalls"
ABC Insurance Network
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