Can rural cooperative medical care be reimbursed across provinces?

Yes, NCMS can be reimbursed across provinces. The inter-provincial medical network settlement and referral form is valid for 3 months. If the extension is not handled in time beyond the validity period, the expenses incurred in the overdue period shall not be included in the scope of direct settlement and reimbursement of NCMS.

In China, 22 provinces have integrated NCMS and urban residents' medical insurance into urban and rural residents' medical insurance, which is managed by the Ministry of Human Resources and Social Security. In September 2017, direct settlement of inter-provincial and non-local inpatient medical expenses can be realized.

1. The proportion of rural cooperative medical insurance in different places.

1.For medical treatment in township health centers, the minimum payment line is 100 yuan, and the reimbursement ratio is 90%.

2.For medical treatment in county-level designated hospitals, the minimum payment line is 200 yuan, and the reimbursement ratio is 82%.

3.For medical treatment in a designated hospital at the municipal level, the starting line is 500 yuan, and the reimbursement ratio is 65%.

4.For medical treatment in provincial designated hospitals, the starting line is 700 yuan, and the reimbursement ratio is 55%; For medical treatment in non-designated hospitals outside the province, the starting line is 1,000 yuan, and the reimbursement ratio is 45%.

2. The process of handling medical reimbursement in other places:

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.

Legal basis: "New Rural Cooperative Medical Cross-Provincial Medical Settlement and Referral Process and Information Exchange Operation Specification (Trial)".

1. On the scope of designated medical institutions. The "Operation Specification" stipulates that the designated medical institutions for cross-provincial medical treatment network settlement and reimbursement refer to the medical institutions selected with networking conditions according to the Notice of the National Health and Family Planning Commission on the Selection and Submission of Information on the New Rural Cooperative Medical System Inter-provincial Medical Treatment Settlement and Reimbursement Network and Pilot Coordination Areas (Guo Wei Ban Grassroots Letter No. 2016 846), and signed a designated agreement with the provincial (or overall regional) health and family planning department to undertake the work of the NCMS cross-provincial medical treatment network settlement and reimbursement. Non-agreed designated referral medical institutions do not undertake inter-provincial referral functions and network settlement and reimbursement work.

The new rural cooperative medical care can be used across provinces, but the reimbursement must be returned to the place where the household registration is located, and it cannot be reported across provinces. Legal basis: "Notice of the General Office of the National Health and Family Planning Commission on Printing and Distributing the Operation Specifications of Designated Medical Institutions for Cross-Provincial Medical Treatment Network Settlement and Reimbursement of Basic Medical Insurance for Urban and Rural Residents (New Rural Cooperative Medicine) (Trial)" Article 3 The designated medical institutions for the cross-provincial medical treatment network settlement and reimbursement of NCMS (hereinafter referred to as designated medical institutions) refer to the designated medical institutions that can be declared by the local health and family planning commissions to the National Health and Family Planning Commission, reviewed by the National Health and Family Planning Commission, and can provide online settlement and reimbursement services for patients referred by the NCMS across provinces.

Article 13: Patients referred to by the cross-provincial medical treatment network shall go through the discharge settlement and reimbursement procedures at the designated window of the designated medical institution.

Taking Linyi City as an example, NCMS can be reimbursed across provinces.

In accordance with the provisions of Article 23 of the Measures for Basic Medical Insurance for Residents of Linyi City, insured residents shall go to designated medical institutions for medical treatment with social security cards or second-generation resident ID cards, and the designated medical institutions shall be responsible for verifying the insured identity and implementing immediate settlement after discharge according to the policy. The expenses incurred should be paid by the basic medical insurance for residents, and the settlement shall be made by the agency and the designated medical institutions.

The inpatient medical expenses incurred by insured residents in designated medical institutions without instant settlement function (including medical treatment in other places) shall be paid by the insured residents first, and shall be submitted to the local agency for review and reimbursement with relevant information in a timely manner after the end of the following year, and shall not be processed after the deadline.

Insured residents should implement the system of primary diagnosis, hierarchical diagnosis and treatment, and step-by-step referral for medical treatment, and generally should follow the principle of "first in the county, then in the city, and then outside the city". For those who need to go through the referral filing formalities in the city but fail to go through the referral filing formalities in accordance with the regulations, the reimbursement ratio of the corresponding level of hospitals will be reduced by 10 percentage points.

If the insured resident is transferred to a designated medical institution outside the city for hospitalization due to special conditions, a transfer certificate shall be issued by a designated medical institution of the second level or above in the insured place, and reported to the county-level agency for the record. If the insured resident needs to be hospitalized in a different place or due to an acute or critical illness, he or she shall, within 5 working days from the date of hospitalization, go through the relevant formalities with the emergency outpatient medical records and other medical records at the handling agency in the place of insurance in accordance with the above provisions.

Rural cooperative medical care can be reimbursed across provinces, and the reimbursement procedures for non-local medical insurance are as follows:

1. The medical expenses of the personal account of the medical residue potato insurance reimbursed by the medical insurance in different places can be reimbursed by the Zigui Medical Insurance Bureau on a regular basis, and the medical insurance funds in the social security card account can be transferred to the bank account, and the outpatient medical expenses that usually occur are paid by Xiaoyuan himself;

2. If hospitalization occurs in the event of non-local medical insurance reimbursement, it needs to be reported to the county medical insurance bureau for the record, and the specific information is as follows:

1) Diagnosis certificate from the hospital at the time of discharge;

2) Discharge summary;

3) Medication schedule;

4) Receipts for medical expenses;

3. Hospitals in other provinces should be designated hospitals for local medical insurance;

4. The reimbursement ratio shall be reimbursed according to the relevant laws, including 88% for the threshold fee of more than 3,000 yuan, 90% for 3,000-5,000 yuan, 92% for 5,000-10,000 yuan, and 95% for more than 10,000 yuan to the maximum payment limit, of which 80% for Class B drugs, 70% for valuable drugs, and 70% for special inspections and special ** such as those who rise.

Legal basisArticle 27 of the Social Insurance Law of the People's Republic of China.

Individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, the cumulative contributions reach the number of years prescribed by the state, and the basic medical insurance premiums will not be paid after retirement, and they will enjoy the basic medical insurance treatment in accordance with the provisions of the state; If the number of years prescribed by the state has not been reached, the fee can be paid until the number of years prescribed by the state.

Article 28.

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance in accordance with national regulations.

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.