The latest policy of inter provincial medical insurance reimbursement, how to reimburse inter provin

How to reimburse medical insurance for out-of-town medical treatment?

Inter-provincial Abihu hospitalization medical insurance can be reimbursed according to the following methods:

1. Those who have not gone through the filing and registration formalities in other places shall return to the social insurance agency in the place of insurance for reimbursement with the list of expenses, charging documents, medical records, diagnosis and treatment certificates and other materials, and after providing the corresponding materials, if the conditions for reimbursement are met, the social insurance agency will reimburse them, and if they do not meet the conditions, they will inform the reason for not reimbursement;

2. Those who have gone through the registration procedures for medical treatment in other places, and those who are in the designated hospitals, can be directly reimbursed when they are discharged from the hospital, and then settled by the Dinghui Shirt Hospital and the social insurance agency.

Social Insurance Law of the People's Republic of China

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit.

The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Arnold answered:

Hello! In 2018, medical insurance can be reimbursed across provinces. However, you need to know whether you are purchasing NCMS or urban residents' medical insurance, and the reimbursement procedures are different between the two.

1. NCMS reimbursement.

NCMS reimbursement requires hospitalization to be reimbursed, and outpatient clinics cannot be reimbursed. Under normal circumstances, it is necessary to provide ID card, diagnosis certificate, discharge record, NCMS certificate, and medical expense invoice to the local health center for review and reimbursement at the time of reimbursement.

2. Medical insurance for urban residents.

For medical insurance reimbursement for urban residents, medical treatment in other places needs to be registered and filed with the medical insurance agency in the place where they are insured, and the medical expenses are paid in full by the individual first. Within one month of discharge, the insured person can go to the medical insurance agency where the household registration is located for reimbursement with the discharge certificate, resident medical insurance, household registration book, original and copy of the patient's ID card, proof of residence in another place or temporary residence permit, etc.

In general, according to the different provinces, cities and counties, the reimbursement ratio is different, but usually the reimbursement is 25% for those who do not transfer to the hospital (local medical treatment), and 45% for the transfer hospital. When reimbursement, you need to bring the diagnosis certificate, discharge record, NCMS certificate, medical expense invoice, medical card, ID card (or household registration booklet) to the local health center of NCMS for review and reimbursement. 2. Inter-provincial reimbursement of medical insurance for urban residents:

According to the provisions of the urban residents' medical insurance policy, the insured must register with the medical insurance agency in the place of insurance in advance for medical treatment in other places, and file (if an emergency patient needs to be hospitalized in a hospital in a timely manner, he or she shall report to the medical insurance agency in the insured place within three days after hospitalization), and the medical expenses shall be paid in full by the individual first. Within 1 month after discharge, the patient should go through the medical expense reimbursement procedures at the medical insurance agency where the household registration is located with the household registration booklet, a copy of the patient's ID card (the identity verification opinion signed by the medical insurance department of the hospital where the patient lives must be stamped with the official seal), resident medical guarantee (card), medical expense invoice and detailed list, discharge certificate, non-local residence certificate or temporary residence permit.

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Different situations have different reimbursement ratios, and the specific ones can be consulted with the corresponding social security or medical institutions in different places.

Hello, yes, but you have to file it first. The general process and required information for filing are as follows, but there may be some slight differences in different regions, which need to be confirmed with the medical insurance agency in the place where the insurance is enrolled. 1. Social security card and ID card are necessary documents 2. Long-term filing personnel fill in the "Registration Form for Medical Treatment in Other Places for Basic Medical Insurance" 3. Those who seek medical treatment abroad due to illness need to provide the "Basic Medical Insurance Transfer to Medical Treatment Filing Form" issued by the local designated medical institutions

Hello, the reimbursement process for medical insurance in other places is as follows: 1. The insured person should bring the discharge summary, invoice, medication schedule, and certificate of medical treatment issued by the unit to the local social security agency for reimbursement; 2. For hospitalization fees, drug fees, etc., you can go directly to the medical insurance office of the hospital to go through the settlement procedures.

Non-local medical insurance reimbursement information: social security card, valid ID card, such as ID card, original voucher of medical expenses, detailed list of expenses, and other required information.

The reimbursement of social security card in different places can be handled in the following ways, as follows:

1. According to the local medical insurance regulations, those who go to other places to see a doctor should first go to the medical insurance agency of the place where they participate in the insurance to go through the registration and filing procedures for medical treatment in other places, and the medical expenses incurred in the other places shall be paid in advance by themselves, and after the medical treatment, they shall go through the reimbursement procedures with the relevant bills to the medical insurance agency in the place of insurance.

2. If the insured place and the place of medical treatment realize the medical insurance network settlement, the personnel who need to go to other places go through the procedures for different medical treatment according to the relevant provisions of the local medical insurance, Chenxiang can go to the place of medical treatment to swipe the medical insurance card for medical treatment, and directly settle the medical expenses, without the need to pay the medical expenses in advance.

3. The insured place has established a cooperative relationship with the place where the insured person wants to go for medical treatment, so that as long as the insured person has gone through the relevant registration and filing procedures with the medical insurance agency in the place of medical treatment according to the regulations, the medical expenses incurred in the place of medical treatment will only be directly entrusted to the medical insurance agency in the place of medical treatment for reimbursement.

The role of the social security card:

The social security card of the People's Republic of China is a unified plan of the Ministry of Human Resources and Social Security, issued by local human resources and social security departments to the society, and is used in various business fields of human resources and social security integrated circuit (IC) card.

The social security card has a wide range of functions. Cardholders can not only pretend to be medical treatment with the card for real-time settlement of medical insurance personal accounts, but also handle pension insurance affairs, job search registration and unemployment registration procedures, apply for unemployment insurance benefits, apply for employment training, apply for labor ability appraisal and apply for work-related injury insurance benefits, and handle relevant labor and social security affairs online. <>

Legal analysis: select the point, file for the record, and seek medical treatment with the card.

Legal basis: Article 2 of the Law of the People's Republic of China on Social Security Insurance Article 2 Employers and individuals shall pay social insurance premiums in accordance with the law. The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance for high-level slag, and maternity insurance, to ensure citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Summary. Inter-provincial hospitalization medical insurance can be reimbursed in accordance with the following methods: 1. If you do not go through the filing and registration procedures in another place, you should take the list of expenses, charging documents, medical records, diagnosis and treatment certificates and other materials, and return to the social insurance agency in the place of insurance for reimbursement, and after providing the corresponding materials, if you meet the conditions for reimbursement, the social insurance agency will reimburse you, and if you do not meet the conditions, you will be informed of the reasons for not reimbursement; 2. Those who have gone through the registration procedures for medical treatment in other places, and those who are in the designated hospital, can be directly reimbursed when they are discharged, and then settled by the designated hospital and the social insurance agency.

Inter-provincial hospitalization medical insurance can be reimbursed in accordance with the following methods: 1. If you do not go through the filing and registration procedures in another place, you should take the list of expenses, charging documents, medical records, diagnosis and treatment certificates and other materials, and return to the social insurance agency in the place of insurance for reimbursement, and after providing the corresponding materials, if you meet the conditions for reimbursement, the social insurance agency will reimburse you, and if you do not meet the conditions, you will be informed of the reasons for not reimbursement; 2. Those who have gone through the registration procedures for medical treatment in other places in Chunhe Huli, and those who are in the designated hospital, can be directly reimbursed when they go through the hospital, and then the designated hospital and the social insurance agency will settle the settlement.

I'm still a little confused, can you be more detailed?

The inter-provincial direct settlement policy for outpatient and inpatient expenses is the same"At present, the inter-provincial direct settlement service for outpatient expenses has covered the overall planning area and 120,000 designated medical institutions. Li Tao, deputy director of the National Health Insurance Bureau, said that there is more than one networked designated medical institution in the county, and the cumulative settlement of outpatient clinics has exceeded 10 million. According to reports, outpatient expenses and inpatient expenses are the same in terms of inter-provincial direct settlement policy:

Directory of places of medical treatment, policies of places of insurance, and management of places of medical treatment. Specifically, it can be explained as follows: the catalogue of medical treatment - when the direct settlement of medical treatment across provinces and places, in principle, the payment scope and relevant provisions of the local regulations for medical treatment shall be implemented, including the basic medical insurance drug catalog, diagnosis and treatment items and medical service facilities, etc., which shall be implemented in accordance with the policy of the place of medical treatment; Policies of the insured place - the minimum payment standard, payment ratio, and the reimbursement policy of the maximum payment limit of the medical insurance ** shall be implemented in the policy of the insured place; Management of the place of medical treatment - when the insured person seeks medical treatment across provinces, he or she must follow the service and management regulations of the place of medical treatment, and the handling personnel of the place of medical treatment shall provide the same handling services as the local insured person for the person in other places.

To put it simply, when seeking medical treatment across provinces and places, the medical insurance can be reported in accordance with the regulations of the place of medical treatment, but the reimbursement ratio and the maximum amount can be reported should be in accordance with the regulations of the insured place. At the same time, the place of medical treatment should provide corresponding services for the insured. In terms of process, the inter-provincial direct settlement of outpatient expenses needs to be filed first.

The insured can handle it through the National Medical Insurance Service Platform APP and the National Remote Medical Treatment Filing Mini Program, etc., without the need to go back to the place of insurance. After filing, patients can inquire about the regulations of the place of insurance and choose a designated medical institution for cross-provincial and remote medical treatment in the place of medical treatment. Then, when the admission procedure, discharge settlement or settlement at the outpatient billing window, the insured person will carry out direct settlement with the original social security card or medical insurance electronic voucher.

There are two situations that can be reimbursed for remote treatment: one is that the hospital where the insurance is located has issued a transfer procedure**, and the other is to seek emergency medical treatment in other places. The ratio needs to consult the local department of medical insurance, and it is usually not much different from the local medical treatment.

The cost of self-financed drugs and examinations cannot be reimbursed in **).

You need to bring the emergency certificate of treatment at the local hospital, a copy of the hospitalized case, the discharge section, etc. (all need to be stamped and confirmed by the hospital), as well as the medical bill, medicines, checklists, etc.

It is recommended that you apply for medical treatment in other places, and register with the social security in the area where you pay in order to be able to report for medical treatment in other places for resale.

Consult your local social security.

Legal basis: Detailed Rules for the Implementation of the Social Insurance Law of the People's Republic of China

Article 8 The medical expenses incurred by the insured persons in the agreed medical institutions, in line with the basic medical insurance drug catalog, diagnosis and treatment items, and medical service facility standards, shall be paid from the basic medical insurance in accordance with the provisions of the State.

If the insured person really needs emergency treatment or rescue, he or she can seek medical treatment in a non-agreed medical institution; The scope of drugs that must be used for rescue purposes may be appropriately relaxed. The specific management measures for medical services for emergency and rescue of insured persons shall be formulated by the overall planning area according to the actual local situation.

Extended Materials. 1. How to use the medical insurance card in different places?

Under normal circumstances, the medical insurance card cannot be used in other places, if it is due to visiting relatives, long-term residence in other places, etc., you can apply to the local social security bureau, and the medical insurance card can be used across regions after the application is accepted. So under what circumstances can the medical insurance card be used in other places?

1.Business trips, family visits, vacations, etc.: In the course of business trips, family visits, and vacations, if there are emergency hospitalization expenses, they can be reimbursed after returning to their hometowns in accordance with the regulations of the place where the medical insurance is located.

2.Retired or long-term residence in another place: In this case, the medical insurance card holder can apply to the medical insurance center where the medical insurance card is located for the retiree to be resettled, and after the processing, he can choose one or two designated hospitals in the place of residence for medical treatment, and the expenses can be reimbursed.

3.Long-term overseas workers: This group of people can also apply for medical insurance for resettlement in other places, which can be applied for by the unit, and choose one or two local designated hospitals for medical treatment. The expenses can be paid by themselves first, and they can be reimbursed after the insurance is enrolled.

2. How to reimburse for remote medical insurance?

So how should the remote medical insurance be reimbursed after the situation of remote medical treatment?

1.Go to the medical insurance center of the insured city to apply for medical treatment in other places, receive three copies of the approval form, and find the medical insurance offices of three (or two) medical insurance designated hospitals at different levels in different places to stamp;

2.Send the above materials to the medical insurance center of the insured place for the record, and you can be hospitalized in another place. Cash advance payment shall be sent back (or returned) to the medical insurance center in the insured place for reimbursement with the settlement bill, discharge summary, and daily list.

Summary. Inter-provincial hospitalization medical insurance can be reimbursed in accordance with the following methods: 1. If you do not go through the filing and registration procedures in another place, you should take the list of expenses, charging documents, medical records, diagnosis and treatment certificates and other materials, and return to the social insurance agency in the place of insurance for reimbursement, and after providing the corresponding materials, if you meet the conditions for reimbursement, the social insurance agency will reimburse you, and if you do not meet the conditions, you will be informed of the reasons for not reimbursement; 2. Those who have gone through the registration procedures for medical treatment in other places, and those who are in the designated hospital, can be directly reimbursed when they are discharged, and then settled by the designated hospital and the social insurance agency.

Inter-provincial hospitalization medical insurance can be reimbursed in accordance with the following methods: 1. If you do not go through the filing and registration procedures in another place, you should take the list of expenses, charging documents, medical records, diagnosis and treatment certificates and other materials, and return to the social insurance agency in the place of insurance for reimbursement, and after providing the corresponding materials, if you meet the conditions for reimbursement, the social insurance agency will reimburse you, and if you do not meet the conditions, you will be informed of the reasons for not reimbursement; 2. Those who have gone through the registration procedures for medical treatment in other places in Chunhe Huli, and those who are in the designated hospital, can be directly reimbursed when they go through the hospital, and then the designated hospital and the social insurance agency will settle the settlement.

Article 29 of the Social Insurance Law of the People's Republic of China The part of the medical expenses of the insured persons that should be paid by the basic medical insurance shall be directly settled and calculated by the social insurance agency and the medical institution and the drug business unit. The social insurance administrative department and the health administrative department shall establish a settlement system for medical expenses for medical treatment in other places, so as to facilitate the insured to enjoy basic medical insurance benefits.