Is the reimbursement rate for remote medical treatment the same as that for local medical treatment?

The reimbursement ratio of off-site reimbursement and reimbursement to local is not the same.

Generally speaking, the reimbursement ratio of medical treatment in other places is lower than that of local medical treatment, and the reimbursement ratio of foreign medical insurance bought in local medical treatment is lower than that of local medical insurance, if it is a primary hospital, the local may be able to reimburse about 80, and only 40 60 in other places.

Since the opening of the policy of reimbursement of medical insurance in other places, it has been convenient for many people in other places. However, for medical treatment in other places, the reimbursement ratio of medical insurance is lower than that of local reimbursement, according to the reimbursement principle of the directory of medical treatment, the policy of the place of insurance, and the management of the place of medical treatment". The proportion of reimbursement in different places should be estimated according to the local ** regulations, and the policies of each place will be different, so you can prepare all the relevant materials first.

Medical Insurance ReimbursementThe reimbursement scope of urban medical insurance refers to all employers in urban areas, as follows:

1. Including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.);

2. Organs, institutions, social organizations, private non-enterprise units and their employees must participate in basic medical insurance;

3. Some cities and towns stipulate that township enterprises and their employees, owners of urban individual economic organizations and their employees should be gradually included in the scope of basic medical insurance (the last one is determined according to the different policies of each locality) and can enjoy medical reimbursement.

Urban medical reimbursement mainly refers to the reimbursement of medical expenses in the hospital in accordance with the relevant regulations of the medical insurance card, and the urban medical insurance is more specific, the project scale and coverage are larger, but the compensation for major diseases or accidents is limited.

[Legal basis].

Social Insurance Law of the People's Republic of China

Article 2: The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth. 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 **.

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.

Generally speaking, the reimbursement ratio of medical treatment in other places is lower than that of local medical treatment, and the reimbursement ratio of foreign medical insurance bought in local medical treatment is lower than that of local medical insurance, if it is a primary hospital, the local may be able to reimburse about 80, and only 40 60 in other places.

The same. The reimbursement rate for remote medical insurance is the same as that for local medical insurance. Also worth noting:

There is no need to report emergencies locally. Non-emergency cases must be reported. At the same time, whether the types of drugs, diagnosis and treatment items, and service facilities to be reimbursed for medical treatment in other places can be reimbursed depends on the local reimbursement scope of the city where the medical treatment is treated.

Medical treatment in other places involves the medical insurance policies of the two places, and the reimbursement rules are mainly based on the following principles:

Reimbursement Coverage: The medical insurance catalogue of the place of medical treatment shall prevail, and the expenses of drugs, diagnosis and treatment items, and service facilities in the catalogue can be included in the reimbursement.

How much can be reported: Subject to the policy of the place where the insurance is insured, including the minimum payment line, reimbursement ratio, maximum limit, etc. In other words, whether the cost can be reported depends on the place of medical treatment; The specific amount you can report depends on the place where you are insured.

Before going through the procedures for medical treatment in other places, it is important to distinguish what kind of situation you belong to.

Living in a foreign country for a long time: Retired elderly people live in other places with their children, or are sent to work in other places by the company for a long time.

Off-site referrals: Local medical conditions are limited, and you need to be transferred to a large hospital in another country**.

Temporary medical treatment:When traveling for a short period of time or on a business trip, a sudden illness requires urgent medical attention. For most areas, out-of-town medical treatment can only be reimbursed for hospitalization and emergency expenses, and general outpatient clinics generally have to pay for themselves.

Only a small number of areas have achieved reimbursement for outpatient services in different places, such as Jiangsu and Anhui.

The so-called remote medical treatment means that the place of medical treatment and the place of medical insurance are not the same place, and they belong to different places. In general, there are the following types of medical treatment for long-term residence in other places, medical treatment for referral to other hospitals, and temporary medical treatment for non-local travel. In the first two cases, the reimbursement ratio for medical treatment is settled according to the place of medical treatment, which may be different from that in the local area, and it is necessary to specifically consider the medical insurance reimbursement policy of the place of medical treatment.

For the third type, if it is an emergency, many cities currently support "treatment first, reimbursement later", but the reimbursement ratio will be reduced. It should be noted that medical treatment abroad cannot enjoy basic medical insurance reimbursement.

Extended information: 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.

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance**

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Seeking medical treatment outside the country.

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, drug fees, etc., you can go directly to the medical insurance office of the hospital to go through the settlement procedures.

[Legal basis].Article 28 of the Social Insurance Law of the People's Republic of China.

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 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 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.

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Hello, glad to have your question, I hope I am a person who helps you. No, generally speaking, the reimbursement ratio of medical treatment in other places is lower than that of local medical treatment, and the reimbursement ratio of foreign medical insurance bought in local medical treatment is lower than that of local medical insurance, if it is a grassroots hospital, it may be reimbursed about 80% locally, and only 40-60% in other places

For those who are hospitalized during the period of residence in a different place, in principle, they shall choose a designated hospital with national network settlement within the scope of their place of residence. If a person living in a different place needs a chronic disease outpatient clinic or a general outpatient clinic**, he or she should choose one of the designated hospitals managed by the medical insurance agreement in his place of residence as his outpatient hospital.

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Questions. There is no transfer procedure, and the reimbursement ratio of rural medical insurance for surgery done in other places is the same as that of the local area?

This reimbursement ratio is different, because the local area is higher, it can reach between 70% and 80%, and then the remote is a little less. At most, it's 60% or 70%. Most are 60%.

Legal analysis: the reimbursement ratio is the same, but the minimum payment is different. If it is an emergency, you do not need to report it locally.

Non-emergency must be reported, otherwise it cannot be reimbursed in other places and reimbursed back to the place where the medical insurance belongs. When seeking medical treatment in other places, whether the reimbursement of the stool banquet drug catalog, diagnosis and treatment items, and service facilities can be reimbursed is subject to the local reimbursement scope of the city where the medical treatment is received.

Legal basis: Article 20 of the Social Insurance Law of the People's Republic of China Article 8 The medical expenses that meet the standards of the basic medical insurance drug list, diagnosis and treatment items, medical service facilities, and emergency and rescue shall be paid from the basic medical high-level insurance in accordance with national regulations.