How is the reimbursement of medical insurance reimbursement for remote medical treatment

1. The inpatient medical expenses incurred after obtaining the medical qualification in other places shall be paid in advance by the individual, and after discharge (after the outpatient serious illness in the remote area has been completed for a medical year or the outpatient medical expenses exceed 5,000 yuan), the relevant qualification approval certificate (the deputy copy of the qualification approval form or the "Outpatient Medical Certificate for Special Diseases"), the discharge record, the copy of the inpatient medical record and the doctor's order, the detailed list, the prescription, the valid charge documents (invoices) and other materials and fill in the "Municipal and Urban Employees Basic Medical Insurance Medical Expenses Review Form". Go to the Municipal Medical Insurance Management Center to apply for reimbursement settlement.

2. When applying for reimbursement of medical expenses in other places, complete original reimbursement materials must be provided in accordance with the above provisions, and incomplete materials should be supplemented, and if complete original materials cannot be provided, the related medical expenses will not be reimbursed.

3. If you do not have the approval of the medical insurance management center and receive medical treatment in other places, or do not treat yourself in other places according to the specific content of the approval, the relevant medical expenses will not be reimbursed.

4. Non-local medical expenses shall be reimbursed in accordance with the scope and payment standards of the overall fund for diseases, medical service items, drugs, medical service facilities and other items stipulated in the basic medical insurance policy of Qingdao.

5. If there is a referral during the medical treatment in another place, a reasonable referral certificate must be provided, otherwise no reimbursement will be made.

6. The proportion of medical expenses borne by individuals for referral from other places (including referral from other places) is 5% higher than that of medical treatment in this city.

7. The labor and social security cards of long-term personnel stationed abroad and those resettled in other places cannot be used in other places, and the funds in their personal accounts shall be issued to individuals in the form of cash by their units.

8. "Non-local" in this notice refers to areas within the territory of the People's Republic of China except Hong Kong, Macao and Taiwan; The basic medical insurance will not pay for the medical expenses incurred by the insured persons abroad or abroad.

The reimbursement process for medical insurance for remote medical treatment is as follows:

1. Prepare the discharge summary, invoice, and medication schedule issued by the hospital;

2. My ID card, medical insurance card, and medical certificate issued by the unit (with the company's official seal), if the enterprise is not insured, the medical certificate issued by the unit is not required;

3. Bring the above information to the local medical insurance office.

Medical insurance card application process:

1. Prepare application materials, original and copy of ID card, one inch **, resignation procedures, copy of household register, renewal medical insurance card, medical records;

2. Then go to the pension insurance institution where the household registration is located to receive the social insurance financial subsidy form, fill it out and hand it in, and submit all the information prepared;

3. The staff will conduct a review of the information provided, which can be completed on the same day and issue payment documents; According to the bank information on the payment slip, regular transfers are sufficient; Bring the first payment slip to the medical insurance hall to get the medical insurance card, some places will have medical records, the medical record is affixed with ** and has a steel seal, you can bring it when you see a doctor.

Legal basisArticle 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 treatment 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.

Article 7. The social insurance administrative department is responsible for the management of social insurance throughout the country, and other relevant departments are responsible for the relevant social insurance work within the scope of their respective duties.

The local people's social insurance administrative departments at or above the county level are responsible for the social insurance management work in their respective administrative regions, and other relevant departments of the local people's social insurance at or above the county level are responsible for the relevant social insurance work within the scope of their respective duties.

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.

Legal analysis: The full amount will be paid by the person first. Within 3 months after discharge, apply for reimbursement to the medical insurance agency where the insurance relationship is located, and the reimbursement procedures will not be handled within the time limit; Special bills for medical services formulated or supervised by the finance and tax departments; A list of expenses, Chinese medicine compounds and related test reports signed and approved by the patient or his/her family members; Issuance of a hospital death certificate; Social security card; ID card of the insured or ** person; A bank savings account designated by the medical insurance agency.

Legal basis: Article 23 of the Social Insurance Law of the People's Republic of China Employees who are in need shall participate in the basic medical insurance for employees, and the employer and the employee shall jointly pay the 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 ways to reimburse for medical treatment in other places are as follows:

1. Pay in advance and then reimburse, the patient will first bear all the medical expenses, and then bring the hospitalization certificate, relevant bills and other materials to the medical insurance bureau where the place is located for reimbursement;

2. Direct settlement, as long as you swipe the social security card, you can directly settle the expenses borne by the individual;

3. For offline filing, bring your valid identity documents, social security cards and other relevant materials to the medical insurance department where the insurance is located to handle the filing of medical treatment in other places;

4. Online channels can be handled through the National Medical Insurance Service Platform, the official website of the National Health Insurance Administration, etc.

The reimbursement conditions for medical insurance in other places are:

1. IC card, basic medical insurance medical card, green sticker**, or basic medical handbook for urban residents;

2. Valid receipts, documents and invoices;

3. Summary list of inpatient medical expenses, referral letter of medical insurance referral and transfer, and discharge certificate;

4. Hospitalization materials: the first page of the inpatient medical record, admission record, surgical record, discharge summary, large-scale examination report, long-term doctor's order, and temporary doctor's order, which need to be stamped with the seal of the medical institution.

To sum up, prepare the discharge summary, invoice, and medication schedule issued by the hospital; My ID card, medical insurance card, medical certificate issued by the unit, need to be stamped with the company's official seal, if not an enterprise insurance, do not need the medical certificate issued by the unit, bring the above information to the local medical insurance office can be handled.

Legal basis

Article 8 of the Regulations for the Implementation of the Social Security Law.

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

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.

The reimbursement process for medical insurance for remote medical treatment 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 and drug fees, you can go directly to the medical insurance office of the hospital to go through the settlement procedures.

Legal basisArticle 28 of the Social Insurance Law of the People's Republic of China.

In line with the medical catalogue of the Zhengben medical insurance, diagnosis and treatment items, medical service facility standards, as well as emergency and rescue medical expenses, in accordance with national regulations, from the basic medical insurance ** branch slag ears quietly paid.