The reporter learned from the Provincial Health Planning Commission yesterday that instant settlement of medical treatment in different places refers to the medical expenses incurred by the insured persons of urban and rural residents in this province in the medical institutions of urban and rural residents' medical insurance agreements outside the insured places, and they are directly settled at the medical treatment place by the residents' health cards (or co-branded cards and medical insurance cards) and referral forms (or medical treatment registration forms in different places).
Those who participate in medical insurance for urban and rural residents will be included in the instant settlement of medical treatment in different places. Including off-site referral, that is, the insured person is transferred to an off-site agreement hospital in the province for hospitalization due to medical conditions and the needs of coordinating regional disease diagnosis and treatment; Emergency treatment in different places, that is, the insured leaves the overall planning place and receives emergency observation (≤72 hours) or hospitalization in different hospitals in the province due to unexpected events; Resettlement in different places, that is, the insured person works in different places or lives in different places with his parents and children for a long time, and agrees to be hospitalized in the hospital where he lives for special chronic diseases; College students seek medical treatment in different places, that is, college students who participate in urban and rural residents' medical insurance are hospitalized in different hospitals due to illness, and special chronic diseases are treated in outpatient clinics during their suspension from school due to illness.
Referral in different places must be handled with my health certificate.
The insured person who is referred to a different place for medical treatment must hold my resident health card (or combined treatment card or medical insurance card) and ID card, and go to the local medical institution with referral qualification to handle the "Shaanxi Province Urban and Rural Residents' Remote Medical Network Referral Form". The insured persons who are resettled in different places must hold their health cards and ID cards, and go to the medical insurance agency for urban and rural residents in the insured place to fill out the Registration Form for Medical Insurance for Urban and Rural Residents in Shaanxi Province, and go through the relevant registration procedures.
Medical expenses incurred by the insured for medical treatment in different places in the province due to emergency and first aid. , should be agreed by the medical institutions according to the emergency, first aid and other related information, to be settled immediately.
The medical insurance hospitalization capping line for urban and rural residents is uniformly implemented in the whole province at 6,543,800 yuan/person/year.
The settlement scope of medical treatment in different places is the medical expenses of hospitalization in different places. Timely expansion to outpatient medical expenses for special chronic diseases. The real-time settlement scope of medical expenses in different places shall be temporarily implemented according to the medical insurance catalogue of urban and rural residents in the place of medical treatment, and shall be implemented according to the unified catalogue of the whole province after the catalogue is unified.
The reimbursement policies of provincial medical institutions for medical treatment in different places in the province are as follows: the deductible lines for reimbursement of secondary and tertiary medical institutions are 2,000 yuan and 3,000 yuan respectively (70% of the deductible lines for children aged 0- 14 are at the same level, and the deductible line for mental illness is 2,000 yuan in tertiary comprehensive or specialized hospitals); The reimbursement rates are 65% and 55% respectively (the reimbursement rate for tuberculosis in tertiary hospitals is 70%). Other cities and counties in the province agree that medical institutions shall determine the reimbursement policy by the medical insurance management institutions of urban and rural residents in the overall planning area. The medical insurance hospitalization capping line for urban and rural residents is uniformly implemented in the whole province at 6,543,800 yuan/person/year. Trauma case data shall be brought back to the medical insurance agency for urban and rural residents by the patients, and shall be investigated, publicized and approved according to the prescribed procedures.
The individual payment part is directly settled with the agreed medical institution by the insured.
The medical expenses incurred by medical personnel from different places in the province in the medical institutions agreed in the province belong to the individual pays part and are directly settled with the medical institutions agreed by the insured. Is part of the urban and rural residents' medical insurance fund payment, by the urban and rural residents' medical insurance agencies in the overall planning area monthly agreement with medical institutions for medical treatment.
For patients who really need to be referred to other places for medical treatment, the application for referral shall be transferred out of the hospital as a whole, and the patients shall be informed to bring the referral certificate, ID card and health card (or joint treatment certificate and medical insurance card) when they go out for medical treatment before they can enjoy the instant reporting service for medical treatment in other places in the province.
When the patient is discharged from the hospital, the following materials should be completed: the electronic scanned copy or photocopy of the patient's identity certificate (ID card or household registration book) and the resident health card (or the participation guarantee and medical security of the insured patient); Copy of the first page of the medical record; Unloading settlement invoice (copy of receipt or invoice); Medical insurance for urban and rural residents in Shaanxi Province: reimbursement form for hospitalization in different places in Shaanxi Province.
Inter-provincial medical treatment in different places does not include overseas medical treatment.
A few days ago, our province issued the "Real-time Settlement Plan of Medical Insurance for Urban and Rural Residents in Shaanxi Province" to facilitate the settlement of medical expenses for insured people across provinces. Among them, medical treatment in different provinces does not include overseas medical treatment.
Overseas medical treatment is not included in cross-provincial medical treatment.
Inter-provincial medical treatment in different places refers to the medical behavior of the insured in other provinces, excluding overseas medical treatment. Inter-provincial instant settlement of medical treatment in different places refers to the behavior that the medical expenses incurred by the insured of urban and rural residents in this province (or other provinces) are directly settled immediately at the place of medical treatment by the resident health card (or co-branded card and medical insurance card) after handling the registration procedures or referral form of medical treatment in different provinces. This scheme is applicable to the instant settlement of medical treatment in different provinces between this province and the agreed provinces (autonomous regions and municipalities directly under the Central Government).
The following persons who participate in medical insurance for urban and rural residents are included in the scope of immediate settlement of medical treatment in different provinces. Including inter-provincial referral, that is, the insured person is transferred to a medical institution in other provinces for hospitalization due to the limitations of medical conditions in this province and the needs of disease diagnosis and treatment. In case of cross-provincial emergencies, the insured goes out of the province, and it is agreed to make emergency observation or hospitalization in medical institutions in other provinces due to emergencies. Inter-provincial resettlement refers to the medical insurance for urban and rural residents who work in other provinces or live in other provinces with their parents and children for a long time, and are hospitalized in the medical institutions where they live and treated in outpatient clinics for special chronic diseases with their consent. College students seek medical treatment in different places, that is, college students who participate in urban and rural residents' medical insurance are hospitalized in inter-provincial medical institutions due to illness, and special chronic diseases are treated in outpatient clinics in other provinces during their suspension from school due to illness.
Outpatient special chronic disease costs will also be included in due course.
The settlement scope of inter-provincial medical treatment in different places is the hospitalization expenses of medical institutions agreed by the insured in other provinces. Timely inclusion of special chronic disease outpatient medical expenses.
Medical insurance personnel who seek medical treatment in different provinces need to hold their resident health cards (or combined treatment cards and medical insurance cards) and identity cards, and go to local medical institutions with referral qualifications to handle the "Inter-provincial and Inter-provincial Medical Network Referral Form for Urban and Rural Residents in Shaanxi Province". Inter-provincial medical insurance personnel who are resettled in different places across provinces must hold their health cards and identity cards, fill out the Registration Form for Medical Insurance for Urban and Rural Residents in Shaanxi Province at the medical insurance agency of the insured place, and go through the relevant registration procedures.
Medical expenses incurred by the insured for inter-provincial medical treatment and hospitalization in other provinces due to emergency and first aid. , should immediately through the agreed medical institutions in the medical treatment place with the relevant first aid and first aid information on the Internet for settlement. According to the agreement signed with other provinces, medical personnel from different provinces shall make medical settlement with their valid ID card and resident health card (or joint medical certificate and medical insurance card).
Inter-provincial medical treatment in different places will be settled immediately, and medical treatment in different places will be managed.
Inter-provincial medical treatment in different places shall be settled immediately, the catalogue of medical treatment places in different places shall be used, the management of medical treatment places in different places shall be implemented, and the reimbursement scheme for insured places shall be implemented. The reimbursement standards for medical treatment in different provinces in this province are: the deductible lines of first-,second-and third-level medical institutions are: 500 yuan, 1500, 5,000 yuan respectively; The reimbursement rates are 80%, 60% and 40% respectively. According to the payment of diseases, the fixed payment standard of diseases is implemented. The medical insurance agency for urban and rural residents shall examine and approve the unified planning of trauma patients according to the prescribed procedures. The top line of basic medical insurance is 6.5438+0.3 million yuan/person/year.
The medical expenses incurred by the insured in the medical institutions agreed in other provinces of this province belong to the individual pays part, and are directly settled by the insured and the medical institutions agreed in other provinces. The part paid by the medical insurance fund for urban and rural residents shall be settled by the provincial medical insurance management and settlement center and its provincial medical insurance agency on a monthly basis.
When the patient is discharged from the hospital, the inter-provincial medical agreement medical institution shall fill in the following materials: the electronic scanned copy or photocopy of the patient's identity certificate (ID card or household registration book) and the resident health card (or the participation guarantee and medical insurance for the insured patient); Unloading settlement invoice (receipt); The basic medical insurance for urban and rural residents in XX Hospital is an inter-provincial medical report on hospitalization expenses.