Declaration materials
(1) Application materials for (emergency) clinic
(1) Receipt of social security declaration (network hospitals need to be stamped with full advance payment) stamp or network failure stamp);
(2) Outpatient fee list (the drug fee list must have an approval number);
(3) The prescription coupon corresponding to the drug fee receipt ;
(4) Purchase medicines at designated retail pharmacies across the city: Prescription drugs must have special invoices and lists (stamped with special medical insurance seals) and corresponding outsourced prescriptions from designated medical institutions (stamped with hospital outsourcing seals) . Over-the-counter drugs need to provide special invoices and lists (stamped with special medical insurance seals), and do not need to purchase prescriptions;
(5) The unit must be arranged in the following order and fill in the following form, and must be declared uniformly by the unit handling personnel
①"Tianjin Outpatient (Emergency) Clinic Large-amount Medical Expenses Subsidy Application and Payment Form" (Tianjin Social Security Medical Subsidy Form No. 8)
②"Medical Expenses Declaration Material Handover Form"
③"Tianjin Outpatient (Emergency) Clinic Large-amount Medical Expenses Subsidy Application and Payment Verification Form" (Tianjin Social Security Medical Subsidy Form No. 9)
④"Tianjin Urban Employee Medical Care "Personal Declaration and Payment Form for Medical Expenses"
⑤"Letter of Commitment to Standardize Medical Expenses Declaration Voucher"
(2) Hospitalization Application Materials
(1) Receipt and Social Security Application Copy (needs to be stamped with hospital medical insurance seal)
(2) Summary details; (needs to be stamped with hospital medical insurance stamp)
(3) Discharge summary (needs to be stamped with hospital medical record room only (stamp)
(4) Diagnosis certificate (need to be stamped with hospital medical insurance stamp and diagnosis certificate stamp)
(5) Units must be arranged in the following order and fill in the following forms, which must be submitted by the unit Unified declaration by handling personnel
①"Transfer Form for Full Advance Payment of Hospital Medical Expenses for Insured Persons (Insured Unit)"
②"Tianjin Basic Medical Insurance Premium Application and Payment Form" (Tianjin Social Security Medical Insurance Form No. 10)
③ "Tianjin Basic Medical Insurance Premium Application Payment Verification Form" (Tianjin Social Security Medical Insurance Form No. 11)
④ "Tianjin "Personal Declaration and Payment Form for Medical Expenses for Municipal and Urban Employees"
⑤"Letter of Commitment to the Standardization of Medical Expenses Declaration Vouchers"
⑥Related Certificates
(3) Outpatient Special Diseases Application materials
(1) Receipt of social security application (network hospitals need to stamp the full advance payment stamp or network failure stamp);
(2) Outpatient fee list (drug fee list) Approval number is required);
(3) The prescription copy corresponding to the receipt;
(4) The unit must be arranged in the following order and fill in the following form, which must be approved by the unit Unified declaration by office personnel
①"Tianjin Basic Medical Insurance Premium Application and Payment Form" (Tianjin Social Security Medical Insurance Subscription Form No. 10)
②"Medical Expenses Declaration Material Handover Form"
③"Tianjin Basic Medical Insurance Premium Application and Payment Review Form" (Tianjin Social Security Medical Insurance Subscription Form No. 11)
④"Tianjin Urban Employee Medical Expenses Individual Declaration and Payment Form"
⑤"Letter of Commitment to the Standards of Medical Expenses Declaration Vouchers"
⑥Relevant Certificates
5. Pasting of Bills
(1) Each The outpatient receipt is a unit, and the corresponding valid bills are a group;
(2) The outpatient receipt is at the top, and the expense list is at the bottom. Paste it into a group with the left alignment vertically;
(3 ) The copy of the report or the bottom copy of the prescription should be folded neatly based on the length and width of the outpatient receipt;
(4) In chronological order from right to left (interval 0.5-1cm), first inside and then outside. Paste each group of bills above the dotted line where the bills are pasted in the "Tianjin Urban Employees' Individual Declaration and Payment Form for Medical Expenses" (hereinafter referred to as the "Payment Form");
(5) For all registration fee receipts and outpatient receipts are numbered in the order of 1, 2, 3...n, and marked in the lower right corner of the receipt;
(6) The expense list may be folded within the scope of the "Payment Schedule";
(7) After verification, fill in all the contents of the "Payment Form", one line for each bill, and the medical examination fee in other items.
VI. Notes
1. The registration slip is pasted separately on another page of the "Tianjin Urban Employees Medical Expenses Personal Declaration and Payment Form", but the number sequence must be consistent with the receipt number. Then, the amount on the registration form will only be filled in with the medical examination fee.
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