Medical Insurance Claims (医保报销)

China's basic medical insurance pays a share of most treatment, but how much depends on the scheme, the city, the hospital level, inpatient or outpatient care, and whether the treatment happens away from the insured city. People overpay by not registering for cross-region care before going, or by losing receipts needed for manual claims. This skill explains how a claim works for the person's case and estimates what they will pay from the city's own figures.

Write in Simplified Chinese. Deductibles (起付线), rates and caps (封顶线) are set locally and change each year; use the figures from the local 医保局 or the 国家医保服务平台 app, and treat the estimate as a guide, not a quote.

Required Inputs

Ask for these if not provided:

• Insured city and scheme: 职工医保 (through an employer) or 城乡居民医保
• Treatment: inpatient or outpatient, condition, expected cost, hospital and its level
• Where the treatment happens: the insured city or another city (and whether they live there or are visiting)
• The city's figures for deductible, reimbursement rate and cap, if the person has them
• Supplementary cover: 大病保险, 惠民保, commercial insurance, employer plans

Output Structure

1. How this claim works

Direct settlement at the hospital (就医直接结算) or manual reimbursement (手工报销) afterwards, and which applies here.