How to reimburse NCMS across provinces, and how to reimburse NCMS across provinces

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.

Inpatient medical records, expense lists, hospitalization invoices, discharge summaries, disease diagnosis certificates, ID cards, household registration books, cooperative medical books (or certificates, cards), transfer procedures or certificates (unit part-time work certificate or emergency certificate). 2. NCMS medical insurance reimbursement process: 1. The materials to be brought when discharged from the hospital should generally be told to the doctor to copy when they are about to be discharged, and the materials will be sent to the medical record room before you can be copied after filing, which will take one to two weeks.

2. The staff should enter all the expenses incurred by the patient in the hospitalization into the computer in order to get the compensation amount of the patient. 3. Under normal circumstances, the bank has no right to refuse to take money, of course, some counties and cities have cashiers who pay special money.

Legal basis: Article 21 of the Social Insurance Law of the People's Republic of China The new type of rural social endowment insurance benefits are composed of basic pensions and personal account pensions. Rural residents who participate in the new rural social endowment insurance and meet the conditions stipulated by the state shall receive the benefits of the new rural social endowment insurance on a monthly basis.

1. If you are in an emergency room, it will be easier to review and generally be reimbursed. It is also necessary to go through the relevant procedures in time after hospitalization, which needs to be in accordance with local regulations. The medical expenses of hospitalization outside the hospital shall be paid by the individual first, and then reimbursed according to the local regulations with the "Approval Form for Medical Treatment in Other Places", the emergency medical records of the hospitals receiving treatment in other places, the discharge summary, the medical record certificate of the employee medical insurance, the detailed list of expenses, and the medical expense settlement documents.

2. If you are hospitalized, it will be difficult to reimburse. It is recommended that you consult your local agricultural cooperative management center directly to confirm the procedures and policies.

How to reimburse NCMS for non-local hospitalization?

Answer social security retirement, 60 years old for men, 50 years old for female workers, and 55 years old for female management and technical positions; In the New Rural Insurance, both men and women are 60 years old to go through the pension procedures.

The State shall establish a nationwide unified personal social security number. An individual's social security number is a citizenship number.

No reimbursement. Trauma reimbursement is conditional, and not all trauma is reimbursed. If there are traffic accidents, fights, medical disputes, suicide and self-injury, work-related injuries, and accidental injuries of the responsible party, which are not reimbursed, and the NCMS determines that the responsible party is responsible, then the medical expenses will be paid by others, and the NCMS will not be reimbursed.

NCMS reimbursement in different places, if you don't pay attention to these problems, the reimbursement will be 20% less, you know?

Legal Analysis: 1. Non-local Referral:

1. Referral procedures: Generally, the attending doctor needs to issue a diagnosis certificate, and then stamp the official seal of the hospital.

2. Fill in the referral application form: The applicant fills in the referral application form, stamps it at the social security window of the hospital, and then the applicant goes to the social security department of the place where the applicant participates in the insurance to go through the filing procedures.

3. Discharge settlement: The applicant holds a social security card to seek medical treatment in a designated medical institution across provinces, and the settlement is made directly at the NCMS window when discharged.

2. He Lang lives abroad for medical treatment: Farmers who have been working abroad for a long time should first go to the social security bureau of the place where they are insured to directly settle and record medical treatment in other places, and then choose a designated medical institution, so that they can seek medical treatment in a designated institution in a different place. The materials required for filing include the original and photocopy of the ID card, the original and photocopy of the social security limb card, and the certificate of long-term residence in a different place.

Legal basis: Article 28 of the Social Insurance Law of the People's Republic of China Article 28 Medical expenses that meet the standards of basic medical insurance drug lists, diagnosis and treatment items, medical service facilities, and emergency and rescue shall be paid from the basic medical insurance in accordance with national regulations.

The specific process of NCMS inter-provincial reimbursement is as follows:

1. The patient's family members should bring the patient's ID card (or household registration book), two one-inch color **, and NCMS medical return certificate to the local agency for referral and filing procedures;

2. Bring the patient's ID card, NCMS medical certificate and referral filing procedures to the referral hospital for medical treatment, and the NCMS hospitalization procedures need to be treated in cross-provincial designated medical institutions;

3. Patient hospitalization**;

4. After discharge, the patient can go to the participating agency for reimbursement with his or her ID card (or household registration book), NCMS medical certificate, copy of medical record, hospitalization settlement statement, list of hospitalization expenses, and referral filing procedures.

The state shall establish and improve a new type of rural cooperative medical system, and the part of the individual contributions required by those who enjoy the minimum living guarantee, the disabled who have lost the ability to work, the elderly over the age of 60 and minors from low-income families, etc., shall be subsidized by **. 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 national regulations.

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

Social Insurance Law 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 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.

NCMS can be reimbursed across provinces, but it is necessary to apply to the local medical insurance office first. The local hospital will issue a transfer certificate to prove that the disease cannot be treated locally and must be transferred to the hospital**, and then reviewed by the local agricultural cooperative office, and after agreeing, you can seek medical treatment in another place, and the cost of medical treatment will be paid by yourself first, and then you will come back to apply for reimbursement; If you seek medical treatment in a different place without approval, you can not be reimbursed.

The reimbursement process is as follows:

1. The person or his family can apply for inter-provincial reimbursement at the place where he or she is insured;

2. Choose to go to the designated hospitals designated by each province for medical treatment;

3. Bring the patient's ID card, or household registration booklet, cooperative medical certificate, admission certificate, referral form, or referral SMS to go through the admission procedures, and settle at the NCMS direct settlement service window when discharged.

Note: If you cannot be reimbursed locally due to special circumstances, you need to issue the "Instructions for Discharged Patients Transferred from Inter-provincial Medical Treatment and Fail to Enjoy Immediate Settlement and Reimbursement Service", and return to the insured place for reimbursement. When reimbursing in a different place, there must be a referral form, and no referral form cannot be reimbursed immediately.

Note that the referral form is limited to 3 months, but it can be extended in some special circumstances.