Can rural cooperative medical care be reimbursed 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.

Rural cooperative medical outpatient services can be reimbursed, as long as the outpatient expenses of the insured persons meet the local outpatient reimbursement amount standard, they can be reimbursed according to the proportion stipulated in the local non-local reimbursement policy.

[Legal basis].

Article 24 of the Social Insurance Law.

The State shall establish and improve a new type of rural cooperative medical system. The management measures for the new type of rural cooperative medical care shall be stipulated by ***.

Article 29 of the Social Insurance Law.

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.

Legal analysis: 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 for 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 inter-provincial medical treatment network settlement and reimbursement of NCMS (hereinafter referred to as the designated medical institutions) refer to the designated medical institutions that are declared by the local health and family planning commissions to the National Health and Family Planning Commission and reviewed by the National Health and Family Planning Commission, and can provide online settlement and reimbursement services for the inter-provincial patients referred by the NCMS.

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.

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. [Legal basis].

Article 4 of the Social Insurance Law of the People's Republic of China stipulates that employers and individuals within the territory of the People's Republic of China who pay social insurance premiums in accordance with the law have the right to inquire about payment records and personal rights and interests records, and to request social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise their own units' contributions for them.

Ask how to reimburse the cooperative medical care in Kwa Province and what to do.

Hello, in the social security ** "basic medical insurance non-local work, residence personnel declaration form", according to the ** fill in the relevant information, and by the foreign medical insurance agency stamp, the application form to the responsible social insurance agency for review, and confirmation, and then to the social security card management department for the province's remote network card card production procedures, with the remote medical application form and hospital receipts and other materials, you can go to the other place to apply for reimbursement. Inter-provincial cooperative medical reimbursement needs to meet the conditions of non-local reimbursement application before you can apply for reimbursement, you can consult the local cooperative medical management center that applies for reimbursement, about "how to reimburse inter-provincial cooperative medical care."

Policies may vary a little from place to place.

Rural cooperative medical care can be reimbursed in other places. The reimbursement policies are different in different places, and the reimbursement methods are also different, which are divided into two types: local reimbursement and local reimbursement.

New Rural Cooperative Medical Reimbursement Process in Different Places:

1. Bring the patient's ID card, two one-inch color **, and NCMS medical certificate to the county joint management office 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 go through the NCMS hospitalization procedures.

3. After discharge, the patient should be reimbursed with the patient's ID card (or household registration book), NCMS medical certificate, copy of medical record, hospitalization settlement statement (some in the form of invoice), list of hospitalization expenses, and referral filing procedures.

Article 23 of the Law on Social Insurance Insurance: 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.