The reimbursement process of remote medical insurance hospitalization, how to reimburse medical insu

Non-local medical insurance can be reimbursed, and emergency inpatient medical expenses incurred in other places due to special reasons such as business trips, family visits, vacations, etc., shall be reimbursed according to the regulations of the insured place. In the case of an emergency, it is allowed to be treated nearby. After that, return to the local medical insurance agency for reimbursement according to the regulations with the valid voucher issued by the hospital.

If you are away for a long time, you can apply for medical treatment in other places in advance.

NCMS Medical Insurance Hospitalization Reimbursement Process:

The reimbursement of NCMS for hospitalization is similar to that for urban residents. Now it is also directly settled and reimbursed at the hospital's medical insurance office.

The process is: when admitting to the hospital, the insured person will first go to the hospital's inpatient billing office to go through the admission procedures and pay the hospitalization deposit with his ID card and the doctor's arrangement.

When discharged, discharge according to the doctor's arrangement, go through the discharge procedures and expense settlement, and then send the receipts, hospitalization documents, ID card, and medical insurance card to the medical insurance office for hospitalization reimbursement.

Reimbursement process for hospitalization of urban residents' medical insurance.

At present, it is also possible to directly handle the settlement directly at the medical insurance office established in the hospital.

The process is: when admitting to the hospital: the insured person shall pay the hospitalization deposit for hospitalization with his ID card and the doctor's admission arrangement.

At the time of discharge: The doctor arranges for discharge, and goes to the hospital's inpatient billing office to settle the discharge fee. Then the hospitalization documents, charging documents, insured medical insurance cards and ID cards are set up in the medical insurance office of the hospital for on-site settlement, and the reimbursement conditions must meet the reimbursement conditions of the resident medical insurance, and the reimbursement ratio is based on the reimbursement level of the hospital, and the hospital has set up a starting point for reimbursement.

The specific policy varies according to local conditions.

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The first step is to fill in the "Long-term Remote Medical Treatment Filing Form" through the national remote medical treatment filing applet or to the local medical insurance handling department for filing; The second step is to select a designated hospital, generally speaking, most of the tertiary hospitals can be settled in different places for social security; The third step is to take our medical insurance card to the designated hospital for direct medical treatment.

There is a very practical **, the country's 12333 official website, and then when you work and live in other cities, you can directly check which hospitals can directly do remote medical settlement, which will be particularly practical.

If you are hospitalized in a different place, and you don't know how to be reimbursed by the medical insurance card, you can pay attention to these points to avoid detours.

Legal analysis: 1. Conditions for reimbursement of medical insurance in different places: 1. Participate in medical insurance in accordance with regulations; 2. It belongs to the period of enjoying medical insurance benefits; 3. Medical expenses that meet the regulations, such as medical expenses incurred in handling referrals from other places in accordance with the regulations, etc.

4. The specific reimbursement conditions shall be implemented in accordance with the local medical insurance policy.

2. Non-local medical insurance reimbursement materials: 1. Social security card; 2. Valid ID card, such as ID card; 3. Original voucher of medical expenses; 4. Summary and detailed list of expenses; 5. Other required information. 6. The reimbursement information is different in different places, and it is implemented in accordance with the local medical insurance policy.

3. Reimbursement process for medical insurance in other places: The applicant can pay the relevant medical expenses in advance, and then bring the above information to the social security institution or medical institution for reimbursement procedures. After review, if the conditions are met, the relevant medical expenses will be reimbursed.

It should be noted that some provinces have opened a settlement system for remote medical treatment in the province, and the insured can be directly discharged from the hospital for settlement, and cross-provincial and remote medical treatment is being piloted.

Fourth, the reimbursement ratio of non-local hospitalization medical insurance: the insured person meets the conditions for referral in other places, and does not go through the procedures for referral in other places according to the regulations (including the transfer of insured persons from other places to other medical institutions), or meets the conditions of emergency and first aid, and does not go through the filing procedures at the specified time, and the medical expenses incurred in hospitalization in other places or non-designated medical institutions, the proportion of personal burden of basic medical insurance is as follows: 1. 40% of the in-service employees and flexible employees who participate in the basic medical insurance for employees and 25% of the retired personnel.

2. 60% of the elderly residents and the disabled participate in the basic medical insurance for urban residents, and 40% of the adult residents, college students and low-income people.

Legal basis: Article 30 of the Social Insurance Law of the People's Republic of China The following medical expenses are not included in the scope of payment of basic medical insurance**: 1. Those that should be paid from work-related injury insurance** 2. Those that should be borne by a third party 3. Those who should be borne by public health and seek medical treatment abroad.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

The insured person shall fill in the "Registration Form for Medical Treatment in Other Places for Basic Medical Insurance" in accordance with the regulations of the place where the medical insurance is enrolled, and provide his ID card, social security card and proof of long-term residence in other places. For online filing, log in to the official website of social security to fill in the filing information, and go to the local social security bureau to fill in the filing registration form for offline filing. For reimbursement of medical treatment in a remote hospital, a "referral and transfer certificate" issued by a local hospital is required, and the filing procedures for medical treatment in other places are also required.

It should be noted that it is more important to find a hospital to issue a "referral and transfer certificate", and the "referral and transfer" must also meet the three conditions of "step-by-step**, expert review, and two-way referral".

Article 23 of the Social Insurance Law of the People's Republic of China stipulates that employees shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state.

Individually-owned businesses without employees, part-time employees who have not participated in the basic medical insurance for employees in the employer, and other flexibly employed persons may participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

The process of handling medical reimbursement in other places is as follows:

1. Before hospitalization or within 3 days after hospitalization, call the hometown NCMS consultation** to register and record the hospitalization and medical treatment;

2. After being discharged from the hospital, a residence certificate must be issued by the sub-district office or neighborhood committee at the place of residence, and if you are working abroad, you must have a work certificate issued by the work unit;

3. After discharge, take a copy of the medical record, a summary list, a hospitalization bill, and a discharge certificate, and then take the patient's ID card, cooperative medical certificate and residence or work certificate back to the place where you participate in the hospital for reimbursement;

4. If you are directly going to the province for chemotherapy from the place where you participate, you must go through the referral and transfer procedures before leaving, and then you can go to other places for hospitalization**;

5. The proportion of reimbursement outside the province is the lowest, the general starting line is about 2000, and the reimbursement ratio is 45% of the reasonable cost.

Reimbursement for medical treatment in other places.

1. The insured person can only seek medical treatment in a designated medical institution in another place after completing the confirmation procedures for medical treatment in a different place, and the amount of his personal medical account can be withdrawn at any business outlet of the medical insurance card for the expenses of general diseases in the outpatient clinic of the ward and the cost of purchasing and dispensing drugs in pharmacies.

Insured persons who are sick and hospitalized (including outpatient specific items**) can go to the identified local designated medical institutions for inpatient and outpatient specific items**, and the medical expenses shall be paid by the individual first, and the insured unit shall apply for reimbursement to the Municipal Medical Insurance Center within 1 month from the date of discharge with the following information.

1. A copy of the front and back of the medical insurance card.

2. A copy of the confirmed Application Form for Medical Treatment in Other Places.

3. Discharge or diagnosis certificate, medical expenses for specific outpatient items shall be attached with a copy of the "Gate Application Form" approved by the Municipal Medical Insurance Center (except for emergency observation).

4. A detailed list of medical expenses.

5. The official receipt of medical expenses (with the signature of the reimburser on the back).

2. When the insured person suffers from an acute illness during a business trip, study or family visit to other places (excluding Hong Kong, Macao and Taiwan), he or she can go to the local public hospital for medical treatment, and the outpatient medical expenses shall be borne by the insured person; The expenses incurred in the approved hospitalization (including emergency observation**) shall be paid in cash by the insured, and the handler shall apply for sporadic reimbursement to the Municipal Medical Insurance Center with the materials.

1. Proof of the insured unit.

2. Copies of the front and back of the medical insurance card.

3. Certificate of discharge or diagnosis.

4. A detailed list of medical expenses.

5. Medical expense invoice (there is a reimburser behind the answer).

6. Copy of inpatient medical record.

The first step is to fill in the "Long-term Remote Medical Treatment Filing Form" through the national remote medical treatment filing applet or to the local medical insurance handling department for filing; The second step is to select a designated hospital, generally speaking, most of the tertiary hospitals can be settled in different places for social security; The third step is to take our medical insurance card to the designated hospital for direct medical treatment.

Legal analysis: The general reimbursement process of non-local hospitalization medical insurance is as follows: if the reimbursement occurs in hospitalization, it is first necessary to report to the local medical insurance bureau for the record, and then when discharged, you can go to the local medical insurance bureau with the hospital's diagnosis certificate, discharge summary, medication schedule, medical expense receipt, medical guarantee and other documents.

Legal basis: "Social Insurance Law of the People's Republic of China" Article 23 Employees shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the basic medical insurance premiums in accordance with the provisions of the state.

Individually-owned businesses without employees, non-full-time employees who do not participate in the basic medical insurance for employees in the employer, and other flexibly employed persons can participate in the basic medical insurance for employees, and the individual shall pay the basic medical insurance premiums in accordance with the provisions of the state.

The reimbursement process for remote hospitalization medical insurance is 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 Gaocha and the place of medical treatment realize the medical insurance network settlement, the personnel who need to go to other places can go to the place of medical treatment according to the relevant provisions of the local medical insurance after going through the procedures for different medical treatment, they 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 bureau in advance after the reimbursement of the medical treatment expenses, this method has been realized in some provinces, and some places have also realized the network settlement between provinces.

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.

Legal basis: 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 by the social insurance agency and the medical institutions and drug business units.

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.

Article 3 of the Supplementary Notice of the National Health and Family Planning Commission and the Ministry of Finance on the Settlement and Reimbursement of New Rural Cooperative Medical Treatment in Other Places regulates the payment process of settlement funds for remote medical treatment: when the participating personnel are referred for cross-provincial and remote medical treatment through standardization, they only need to pay their personal out-of-pocket expenses when they are discharged, and the designated medical institutions will pay the settlement compensation costs for remote medical treatment in advance. Designated medical institutions regularly submit payment materials to the provincial-level NCMS agency in the place of medical treatment, and apply for advance payment of funds.

The provincial-level NCMS agency at the place of medical treatment shall review the application materials for advance funds of the designated medical institutions, and regularly allocate the settlement compensation expenses for remote medical treatment to the designated medical institutions according to the approved amount. For some designated medical institutions that occupy a large amount of funds, the provincial agency at the place of medical treatment may prepay part of the funds to them.

Legal analysis: The process of handling medical reimbursement is: 1. Before hospitalization or within 3 days after hospitalization, call the hometown NCMS Consultation ** to register and record the hospitalization and medical treatment 2. After discharge, a residence certificate must be issued by the sub-district office or neighborhood committee at the place of residence, if it is a migrant worker, a work certificate issued by the work unit is required 3, and after discharge, a copy of the medical record, a summary list, a hospitalization fee bill, and a discharge certificate are held, and then the patient's ID card is held. Cooperative medical certificate and proof of residence or work back to the place of participation in the reimbursement 4, if it is from the place of participation directly to the province for inpatient chemotherapy, you must go through the referral and transfer procedures before leaving, and then you can go to the other place for hospitalization**5, the proportion of reimbursement outside the province is the lowest, the general starting line is about 2000, the reimbursement ratio is 45% of the reasonable cost, if you spend less, it is difficult to reimburse a few dollars, the lower the hospital level, the higher the reimbursement ratio.

Legal basis: "Social Insurance Law of the People's Republic of China" Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and medical expenses for emergency diagnosis and rescue, in accordance with national regulations from the basic medical insurance **.

Legal analysis: The process of handling medical reimbursement in other places is: 1. Before hospitalization or within 3 days after hospitalization, call the hometown NCMS Consultation ** to register and record the hospitalization and medical treatment 2. After discharge, a residence certificate must be issued by the sub-district office or neighborhood committee in the place of residence, if you are working abroad, you need to have a work certificate issued by the work unit 3, after discharge, hold a copy of the medical record, a summary list, a hospitalization fee bill, a discharge certificate, and then take the patient's ID card, Cooperative medical certificate and proof of residence or work back to the place of participation in the reimbursement 4, if it is from the place of participation directly to the province for inpatient chemotherapy, you must go through the referral and transfer procedures before leaving, and then you can go to the other place for hospitalization**5, the proportion of reimbursement outside the province is the lowest, the general starting line is about 2000, the reimbursement ratio is 45% of the reasonable cost, if you spend less, it is difficult to reimburse a few dollars, the lower the hospital level, the higher the reimbursement ratio.

Legal basis: "The People's Republic of China and the State Social Insurance Law" Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses, in accordance with the provisions of the state from the basic medical insurance **.