(1) Measures for reimbursement of local residents' medical insurance designated hospitals
1. Within three days after admission, the patient shall go through the medical insurance registration formalities at the medical insurance office of the designated hospital with the admission notice and medical insurance certificate. During hospitalization, the medical insurance certificate shall be kept by the medical insurance office of the hospital and returned to me at the time of discharge settlement.
If you don't register for more than three days, the hospitalization expenses will be borne by yourself.
2. When you leave the hospital, you should go to the hospital medical insurance office to go through the medical insurance discharge settlement procedures.
3. If the insured residents pay the medical insurance premium in full and on time, the medical expenses paid by the medical insurance pooling fund when the patients leave the hospital will be directly reimbursed by the hospital.
(2) Referral and referral reimbursement methods
1, if residents really need to be hospitalized outside the city, they need to be referred to the Central People's Hospital or Chinese Medicine Hospital of our city. After the director of the department signs and agrees, he can be transferred to the municipal medical insurance agency for hospitalization. If it is transferred outside the city without approval, its medical expenses shall be borne by itself.
2, the transfer of medical expenses by the medical insurance agencies to accept reimbursement, need to provide the following materials:
(1) Transfer Approval Form;
(2) A complete copy of hospital medical records (seal);
(3) Original invoice (seal);
(4) Summary table (seal);
(5) medical insurance certificate.
(3) The reimbursement method for resettlement in different places
1. Go through the registration formalities: medical insurance participants who have lived continuously in different places for more than 1 year can receive the Medical Insurance Registration Form for People Living in Different Places (in triplicate) from the medical insurance management department and send it to people living in different places. The insured chooses three public hospitals in his place of residence as designated hospitals (Grade I, Grade II and Grade III respectively), and the contents are complete, confirmed by the medical insurance department, and entered into the medical insurance after being audited by the medical management department. You also need to provide a copy of the off-site real estate license or proof of residence.
2. Reimbursement method: The medical expenses of people resettled in different places shall be reimbursed by the medical insurance department, and the materials required for reimbursement include:
(1) A complete copy of the inpatient medical record (seal);
(2) Original invoice (seal);
(3) Summary table (seal);
(4) Medical insurance handbook;
(5) my identity card. 165438+ 10 accepts the annual hospitalization expenses in different places from January to February of the following year, and centrally reimburses them at the beginning of the following year. Cross-year hospitalization expenses are not accepted.
(4) reimbursement methods for business trips and family visits
1. If the insured person is hospitalized in the emergency department of the designated foreign medical insurance hospital for business trip, visiting relatives and other reasons, the patient himself or his family members should inform Tengzhou Medical Insurance Office for filing within three working days after hospitalization. The cost of not registering for the record is self-care.
2. When handling reimbursement, I must bring the following information to the medical insurance office.
(1) certificate of the insured unit (village, neighborhood Committee);
(2) proof of residence at the place of business trip or visiting relatives;
(3) The medical expenses of this hospitalization;
(4) The emergency diagnosis certificate of this hospitalization (stamped with the official seal of the hospital);
(5) A copy of the hospitalization medical records includes the hospitalization home page, hospitalization records, discharge summary, long-term and temporary medical orders;
(6) Detailed summary of hospitalization expenses (the above materials shall be stamped with the seal of the hospital);
(7) A copy of the patient's medical guarantee and ID card.
(5) reimbursement methods for medical expenses in community outpatient clinics.
Insured residents to "residents medical insurance card" to the designated community service station (center) outpatient medical treatment, outpatient medical expenses, by the community medical service station (center) for immediate settlement reimbursement procedures.
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