How to reimburse outpatient medical insurance in other places, and how to reimburse outpatient medic

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.

How to get medical insurance reimbursement in different places? If you understand these, you can also be reimbursed for remote emergency 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.

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.

At present, there are roughly two ways to reimburse medical insurance for medical treatment in other places:

1. Pay in advance and then reimburse.

This is the most common way in the past, after the insured person seeks medical treatment in a different place, he first bears all the expenses by himself, and then goes to the local medical insurance bureau for reimbursement with the relevant ** certificate and bill after discharge.

2. Direct settlement.

This is the work that the National Health Insurance Administration is currently focusing on, which can realize the real-time settlement of outpatient and inpatient expenses.

This means that when we pay for outpatient or hospitalization, we can directly settle the expenses borne by the individual as long as we swipe the social security card, and the expenses borne by the medical insurance are directly settled by the medical insurance bureau and the hospital, so we don't have to pay in advance and then go back to the insurance place for reimbursement, which is very convenient!

At present, the inter-provincial direct settlement of hospitalization expenses has covered all the overall areas in the country, and the inter-provincial direct settlement of general outpatient expenses has covered 70% of the overall areas in the country, and full coverage will be achieved by the end of 2021.

How to apply for direct settlement for medical treatment in other places

If we want to realize the direct settlement of medical treatment in other places, we score three steps: check the point - re-filing - medical treatment with a card.

1. Check the point.

Pay attention to the National Health Insurance Bureau***, go to the National Medical Insurance Service Platform** or **"National Medical Insurance Service Platform" APP, you can inquire about the pilot areas of cross-provincial and remote medical treatment hospitalization and outpatient expenses, as well as designated institutions that can provide cross-provincial direct settlement services.

2. Re-filing.

Submit the registration and filing form and related materials for cross-provincial and remote medical treatment to the handling agency in the place of insurance, and some provinces, autonomous regions and municipalities have opened channels such as ** filing, online filing and mobile APP. You can also file online through the "National Medical Insurance Service Platform" APP and WeChat mini-program "National Remote Medical Treatment Filing".

3. Seek medical treatment with a card.

At present, the voucher for the direct settlement of medical insurance for employees and urban and rural residents across provinces and places is a social security card of the national unified standard, and some cities have opened the use of medical insurance electronic vouchers, which can realize the settlement of medical treatment without a card.

The process of medical insurance for medical treatment in other places is as follows:

1. If you want to use medical insurance for medical treatment in other places, you must first pay the full amount of medical expenses in advance.

2. Within one month after discharge, patients can go through the medical expense reimbursement procedures at the medical insurance agency where their household registration is located with their household registration booklet, copy of the patient's ID card, resident medical guarantee (card), medical expense invoice and detailed list, discharge certificate, proof of residence in another place or temporary residence permit.

3. If you need to use a medical insurance card in other places, you need to take out the money to pay in advance, and then wait until you return to the local city, you need to go to the medical insurance center to declare before you can get the medical insurance card.

4. This requires a series of supporting materials such as the certificate of purchase of drugs, which also includes the cost of drugs required for hospitalization. The medical insurance card can be used in other places, but the process is more cumbersome.

5. If the supporting materials are incomplete, it will also affect the reimbursement, and even the expenses will not be reimbursed, which is equivalent to the loss of the medical insurance card.

6. Although the medical insurance card can be used, it is also used indirectly, and it is not the same as people imagine that the handling fee needs to be deducted for the inter-bank use of the bank card in different places.

For some people who are hospitalized in other places, if they need to reimburse the expenses, they need to pay attention to contacting the local medical insurance center in time and collect the proof materials according to the prompts of the medical insurance center, which will be more convenient.

Non-local medical insurance outpatient reimbursement refers to the reimbursement of medical expenses through medical insurance reimbursement after medical treatment in other places. The following is relevant information about outpatient reimbursement for remote medical insurance.

First of all, before seeking medical treatment in a different place, you need to apply for a medical insurance record for cross-provincial and remote medical treatment. Specifically, you can bring your valid identity card, resident medical insurance card, medical treatment form issued by the hospital you visited, and the doctor's diagnosis certificate to the nearest community health service center or local medical insurance agency to submit an application and go through the inter-provincial service filing procedures. After the ICP filing is successful, you can enjoy medical insurance reimbursement treatment in other places.

Secondly, when seeking medical treatment in a different place, you need to choose a cooperative medical institution and a designated medical institution in the local insurance area. Normally, reimbursement for remote medical treatment is only for medical expenses provided by designated medical institutions. Therefore, when choosing to seek medical treatment, you can consult the medical insurance agency in the place of insurance or consult the ** group to understand the specific policies and information of designated institutions for medical reimbursement in other places.

Then, during the medical treatment, you need to keep the receipts and invoices for the medical expenses in a safe place. These vouchers and invoices will be used as the basis for your reimbursement and should be kept properly and the relevant information should be filled in properly.

Finally, off-site reimbursement usually takes the form of advance payment and then reimbursement. Specifically, when seeking medical treatment, you need to pay the medical expenses by yourself first, and after obtaining the payment voucher, you can go to the medical insurance agency in the insured place to go through the reimbursement procedures after returning to the insured place with the relevant vouchers and invoices. In general, you need to fill in the reimbursement application form, submit relevant vouchers and invoices, and the handling agency will review and arrange the reimbursement within a certain period of time.

It should be noted that the medical insurance policies in different regions may be different, and it is recommended that you consult the local medical insurance agency or the social security department of the place where you participate in the insurance for the specific reimbursement policies and procedures of the outpatient medical insurance in different places for the most accurate information and guidance. At the same time, it is also important to keep abreast of and pay attention to changes in medical insurance policies. <>

[Legal Analysis].：1.First of all, a referral certificate from a county-level hospital or above.

Take the medical insurance of 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. 2.Go to the social security window of the hospital to get a stamp.

The social security window of the hospital will generally be set up at the toll gate, and you will go to the window Tuanzhou with the referral certificate. 3.Go to the local social security office to register for an out**.

4.After going out**, get back to the county-level social security bureau for reimbursement.

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

Article 32 If an individual is employed across the overall planning area, the basic medical insurance relationship shall be transferred with him/her, and the payment period shall be calculated cumulatively.

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.

Out-of-town hospitalization medical insurance reimbursement:

1. According to the policy of urban residents' medical insurance, the insured must first register and file with the medical insurance agency in the place where the insured person seeks medical treatment in another place. (If an emergency patient needs to be hospitalized in a timely manner if he or she is sick in another place, he or she shall report to the local medical insurance agency** within 3 days after hospitalization), among which the medical expenses incurred by the insured must be paid in full by the individual first.

2. Within one month after discharge, the insured person can go through the medical expense reimbursement procedures at the medical insurance agency where the household registration is located with the ID card, household registration booklet, resident medical insurance card, discharge certificate, medical expense invoice and hospital expense list, non-local residence certificate or temporary residence permit.

3. When the medical personnel are hospitalized, they must report to the medical insurance center of the insured place for the record, and if the insured person does not go through the reporting procedures in accordance with the regulations, the medical insurance institution may not reimburse the medical expenses incurred in hospitalization.

When reimbursement is made in other places, it is necessary to register and file with the medical insurance agency in the place where the insurance is enrolled, and the medical expenses incurred should be paid in advance by the individual. After discharge, some supporting materials for reimbursement should be reimbursed to the medical insurance agency where the insured person's household registration is located for reimbursement of medical expenses.

Materials required for reimbursement of outpatient treatment in other places

1.Specific outpatient visits:

Due to the specific outpatient disease handled in the selected medical institutions outside the city, the insured person cash in full advance, within the year with the following information to the city's social security agencies (towns) for specific outpatient sporadic reimbursement procedures:

1) Original receipt (invoice) of outpatient charges.

2) Original detailed list of medical charges.

3) A copy of the outpatient medication prescription and a copy of the report of the examination and laboratory results.

4) The original and copy of the "Municipal Basic Medical Insurance Insured Person's Approval Opinions on Medical Treatment in Other Places".

5) The original and the front and back copies of the social security card or ID card, and if the agent is handled by others, the original ID card or social security card and the front and back copies of the agent must be provided at the same time.

6) Other materials stipulated by the social security department.

2. The "Declaration Form" filled in according to the regulations and stamped and recognized by the foreign social insurance (medical insurance) agency;

3. The completed "Declaration Form" will be returned to the social insurance agency responsible for the division of labor for review and confirmation. If you need to apply for a medical card in a different place in the province, you can register with the Audit Department of the Municipal Social Security Center with the "Declaration Form" after review and confirmation, and then go to the Social Security Card Management Department to go through the card production procedures for the remote network card in the province;

4. The personal social security card of the insured person cannot be used after the registration; If the insured person returns to the medical treatment, he or she should go to the municipal social security institution to cancel the medical report, and his personal social security card can be used in the designated medical institution from the next day;

5. The principle of reporting if there is a change in the medical report and not reporting if there is no change.

Legal basis: Article 23 of the Social Insurance Law of the People's Republic of China 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.

Workers who seek medical treatment in other places can bring their social security cards or medical insurance cards, identity documents, medical fee receipts, inpatient medical records and other materials to designated medical institutions or pharmacies for reimbursement. At present, a settlement system for medical expenses for medical treatment in other places is gradually being established, so reimbursement can generally be made in other places.

Article 26 of the Social Insurance Law of the People's Republic of China 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 of the Social Insurance Law of the People's Republic of China in accordance with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **. Article 29 of the Social Insurance Law of the People's Republic of China for the Blind and Prudent 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 Ministry of Social Insurance Administration and the administrative department of health shall establish a settlement system for medical expenses in other places to facilitate the insured to enjoy basic medical insurance benefits.

Social insurance is no stranger to most people, and China's law compels units to pay social insurance including medical insurance for individuals. Residents can be reimbursed part of the cost with their medical card when they seek medical treatment in the local area.

1. How to reimburse medical insurance in other places.

If you are reimbursed by medical insurance in other places, you need to bring the emergency certificate of treatment in the local hospital, the copy of the hospitalization case, the discharge section, etc. (all need to be confirmed by the hospital), and you should also bring the medical invoice and medicine, check list, etc., to the designated department where the insurance is located to apply and record.

2. What materials are required for reimbursement for medical treatment in other places?

a) Basic materials. Under normal circumstances, the reimbursement of medical insurance in other places requires the provision of inpatient medical records, expense lists, original vouchers and key certificates of medical expenses, discharge status certificates (including ** passes), medical insurance card, personal bank (copy), ID card, household registration book, transfer procedures or certificates, valid hospitalization invoices and other materials.

2) Long-term off-site work. A copy of the valid labor contract signed between the insured and the employer, the record book of medical insurance for medical treatment in other places, or the certificate of assignment and relevant materials of the employer (all of which must be stamped with the official seal of the employer), and the business license of the employer.

3) Long-term residence in other places. If the place of residence is the place of household registration, a copy of the relevant household registration certificate shall be provided; If the place of residence is not the place of household registration, the original certificate of continuous residence for more than 6 months or a copy of the temporary residence permit issued by the police station, sub-district, or neighborhood (village) committee of the place of residence shall be provided. If the employee has lived in another place for more than 6 months, the original of the relevant explanation issued by the unit and a copy of the applicant's ID card shall be provided, and a copy of the ID card of the entrusted person shall also be issued if the employee entrusts another person to handle the application.

3. How long does it take for the reimbursement of hospitalization in other places to arrive?

About 30 days. Reimbursement procedures for out-of-town medical treatment: bring the patient's blind and cautious certificate, two one-inch color certificates**, and the NCMS medical certificate to the county joint management office for referral and filing procedures; Bring the patient's ID card, NCMS medical certificate and referral filing procedures to the referral hospital for medical treatment, and go through the NCMS hospitalization procedures; After discharge, the patient should be reimbursed with his/her ID card (or household registration book), NCMS medical certificate, copy of medical records, hospitalization settlement statement (some in the form of invoices), a list of hospitalization expenses, and referral filing procedures.

I believe that after reading the above introduction, you should also know that when we make medical insurance reimbursement, it must be carried out in accordance with the relevant laws and regulations, which is the correct operation, otherwise it will not be reimbursed.

Article 28 of the Social Insurance Law of the People's Republic of China in accordance with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **. 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 Ministry of Social Insurance Administration and the administrative department of health shall establish a settlement system for medical expenses for medical treatment in other places to facilitate the enjoyment of basic medical insurance benefits by insured persons.