How to reimburse hospitalization expenses with medical insurance in other places

How is it reimbursed by medical insurance for hospitalization in other places?

First of all, a referral certificate from a county-level hospital or above. Take the medical insurance in a small town as an example, if you want to go to a different place for medical treatment, you must first go to a county-level hospital or above, and generally there will be a county-level hospital in the town, so that the doctor can issue a referral certificate.

The second step is to go to the social security window of the hospital to get a stamp. The social security window of the hospital is generally set up at the toll gate, go to the window with the referral certificate, and the staff over there will naturally know how to help you get it!

The third step is to go to the local social security office to register for going out**. Generally, there are social security offices in cities and towns, and you can check the address of the social security office. Because it's a branch, it may be in an inconspicuous place

The fourth step is to get back to the county-level social security bureau for reimbursement after going out**. After completing the above three steps, you can go to the hospital in a big city**, and you can bring the invoice, medical book, social security card, and household registration book to your superior social security bureau to reimburse!

If it is only an outpatient clinic, you don't need these procedures, you can go directly to the outside to see a doctor first, and then come back to the Social Security Bureau for reimbursement.

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.

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 place of insurance within three days after hospitalization), and the medical expenses shall be paid in full by the individual first.

How to use medical insurance reimbursement for medical treatment in other places? I'll tell you.

For hospitalization in other places, you need to pay in advance from the individual first, and then go to the Social Security Bureau for reimbursement.

The reimbursement rate for hospitalization is at least 50%.

1. Non-local medical insurance reimbursement conditions: positive return.

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.

The specific reimbursement conditions are implemented in accordance with the local medical insurance policy.

2. Reimbursement information for medical insurance in different places.

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.

The reimbursement information is different in different places, and the specific implementation is in accordance with the local medical insurance policy.

3. Reimbursement process for medical insurance in different places.

The applicant can pay the relevant medical expenses in advance, and then bring the above materials to the social security institution or medical institution for reimbursement. After review, if the conditions are met, the relevant medical expenses will be reimbursed. It should be noted that some provinces have opened a system for medical treatment in different places 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.

4. Reimbursement ratio of medical insurance for hospitalization in other places.

If the insured person meets the conditions for referral from another place, and fails to go through the referral procedures in other places according to the regulations (including the transfer of insured persons from other places to other medical institutions), or meets the conditions for emergency and first aid, and fails to go through the filing procedures at the specified time, the medical expenses incurred in hospitalization in other places or in 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; 25% for retirees;

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

[Legal basis].

Article 2 of the Social Insurance Law of the People's Republic of China The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, etc. Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State. Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

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 non-local hospital, the local hospital needs to issue a "referral and transfer certificate", and it is necessary to go through the filing procedures for medical treatment in other places.

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 Law of the People's Republic of China on Social Insurance with Remorse shall allow employees to 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 employees who are employed in the company 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.

[Legal Analysis].: The reimbursement process for medical insurance in other places is as follows:

1. The insured person shall bring the discharge summary, invoice, medication schedule, and certificate of remote 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.

[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 facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

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.

The above is only the current information combined with my understanding of the law, please refer to it carefully!

If you still have questions about this issue, it is recommended that you organize the relevant information and communicate with a professional in detail.

If the user seeks medical treatment in a different place, he or she can pay the medical expenses in advance first, and then the insured person can bring the discharge summary, invoice, medication schedule, and medical treatment certificate issued by the unit to the local social security agency for reimbursement. In addition, users can also do a good job of filing for medical treatment in other places, as long as the insured person does a good job of filing and registration, seeking medical treatment in the designated hospital, and then bringing the social security card to handle the admission registration and discharge settlement.

When the user goes through the filing, the insured needs to fill in the "Registration Form for Remote Medical Treatment of Basic Medical Insurance" in accordance with the regulations of the place where the medical insurance is enrolled, and provide the insured's ID card, social security card and proof of long-term residence in another place. After the completion of the filing business, the medical expenses can be settled directly without the need to pay in advance. Even if you are a registered user, you must bring your medical insurance card when you go through the admission registration and discharge medical fee settlement.

If the user applies for hospitalization reimbursement in accordance with the above two situations, during the reimbursement process, for hospitalization expenses, drug expenses, etc., he can directly go to the medical insurance office of the hospital to go through the settlement procedures. Among them, the place of medical insurance participation and the place of residence are not the same place, and medical expenses need to go through the medical insurance reimbursement process in other places before they can be reimbursed.

The process of handling medical reimbursement in another place is as follows:1. Before hospitalization or within 3 days after hospitalization, call the hometown NCMS consultation** to register and record the hospitalization.

2. After being discharged from the hospital, a residence certificate must be issued by the neighborhood office or the neighborhood committee at the place of residence.

Conditions for reimbursement of medical insurance in other places:Insured persons who have gone through the registration and filing procedures for medical treatment in other places, such as resettlement, family visits, work and study abroad, etc., have paid cash in cash for medical expenses incurred in designated medical institutions for medical insurance in other places. Provincial-level insured persons have agreed to transfer to designated medical institutions in Beijing and Shanghai for medical treatment in cash for medical expenses.