Job description:
(a) to participate in the comprehensive medical insurance insured shall not apply for binding or change the binding;
(two) if the community health has not been bound, there are units, to remind the unit to bind as soon as possible. If there is no company, you can choose to bind yourself;
(3) Only people with normal insured status can apply for binding or change binding;
(four) the lost social security card can not be bound or changed;
(five) the insured person is not satisfied with the social health binding, you can change the binding, but not to use it again within 3 months;
(6) Apply for binding or change of binding before 19 every month, which will take effect the following month. Applications submitted after 19 are regarded as applications for the following month;
(7)/kloc-Insured persons under 0/4 years of age can be bound to community health points or hospitals below level 2 for treatment. /kloc-Insured persons aged 0/4 and above can only bind social security points.
First, the unit binding refers to the overall binding or change of the social health center of enterprises participating in hospitalization medical insurance or migrant workers' medical insurance.
(1) Accepting institution
For the first time, the handling unit is bound to the collection department of the territorial social security institution, and the change of the social rehabilitation center is handled in the newly selected social rehabilitation center.
(two) to accept the materials to be provided and review them.
1. Check the original ID card of the social security agent and get a copy.
2. Certificate of acceptance unit (including unit name, unit number, name of manager, etc.). ).
3, the employer selected medical institutions application form.
(3) Commitment period
Apply before 19 every month (inclusive) and take effect on 1 9 the following month; It will not be accepted after 19.
(4) Binding operation of designated community health centers.
When an enterprise needs to bind or change the community health center as a whole, the social security agent of the enterprise must provide the original ID card and the unit certificate (including the name of the unit, social security code and the full name of the agent, and it is clear that he is the only agent at present). After verification, the copy of the ID card and the unit certificate will be collected and filed for future reference by the social security department.
Online hospital binding operation: After entering the interface of online medical insurance standardized information system, click Basic Medical Care-Basic Management-Unit Binding to enter.
Operation interface display
1, company binding page:
Enter the company code and submit it to complete the registration operation of company binding. If the company code does not exist, it will prompt "No company information with this number!"
2. The company binding display page:
Verify the company information and click "bind current social health" to bind it, as shown in the following figure.
The binding prompt box pops up. Click OK to bind the company, or click Cancel to exit the current binding.
When the company binds, whether it can be bound is judged according to the following criteria:
(1) Whether the company file exists;
(2) Whether the unit payment status is normal;
(3) Only enterprises and government agencies can be bound;
(4) Whether the agency code exists when reading the agency code base of the community health point;
(5) Whether medical institutions are disabled when reading the code base of community health centers;
(6) Judge whether the company binding information is being used by other users, please try again later;
(7) Whether the unit binding point is the same as the current social welfare institution (if it is the same, it will not be handled)
If the binding conditions are not met, all possible error messages are as follows:
◇ The code of this social health center does not exist, and the binding relationship cannot be established!
◇ This social health center is not qualified for binding, and the binding relationship cannot be established!
◇ The original binding record has been locked and cannot be changed temporarily. Please try again later!
◇ There is a medical insurance payment record this month. Please go through the change and binding procedures next month!
◇ The medical insurance premium has not been paid, and a new binding relationship cannot be established!
◇ The company number does not exist, please check it carefully and re-enter!
◇ The company has suspended the insurance payment at present, and the binding relationship cannot be established!
◇ The company does not need to establish a company binding relationship!
3. If the binding is successful, you can print the company binding confirmation page.
Second, personal binding.
Refers to the insured person holding a medical insurance card to the designated social health center for binding.
(1) Accepting institution
Medical insurance for migrant workers designated social medical center.
(2) Accept the object
1. The insured persons of hospitalization medical insurance in useless units include unemployed persons who receive unemployment benefits, some rural urban residents, low-income people, disabled people, poor people, non-deep-household retirees who receive pension insurance on a monthly basis, and other special personnel stipulated by the municipal government.
2. Enterprise employees who have opened the "Authorized Individual Binding Community Health Center" can personally bind the community health center.
(three) to accept the materials to be provided and review them.
1, check personal labor security card or IC card.
2, fill in the application form for individual selected medical institutions (enterprises with more personnel can list or spreadsheet, the items include name, gender, age, medical insurance card computer number).
(4) Commitment period
Only before 1 9th of each month (including19th), it will take effect on19th of the following month, and it will not be accepted after19th of each month.
(5) Binding operation of designated community health centers
1, the procedures for the insured of useless units to choose community health centers as individuals.
When the insured person of useless unit chooses the community health center as an individual, the staff of the community health center will check the ID card and the medical insurance card of the insured person, and after verifying that the cards match, directly log in to the online medical insurance standardized information system, basic management and personal binding, read the medical insurance card and submit it, thus completing the operation of selecting the community health center.
Operation interface display
1, enter the personal binding registration card page:
Swipe the card to enter the personal binding page. If the card is not read correctly, an error message will be displayed at the bottom of the page.
2. Enter the personal binding display page:
A binding confirmation prompt box will pop up. Click OK and this person will be bound. If you click Cancel, you will cancel and exit the binding.
The basis for judging whether to perform personal binding operation is as follows:
(1) Whether the personal file exists;
(2) Whether he died or surrendered himself;
(3) Whether the security card has been reported lost;
(4) Whether it is allowed to establish a personal binding crowd, among which
The nature of the unit is' enterprise retirement medical care' or' institution retirement medical care', and non-registered retirees can be bound;
People whose company nature is' individual payment' or' unemployment medical care' can be bound;
People who are' organs' in nature and are not registered for hospitalization insurance can be bound;
People with the nature of' enterprise' and low subsistence allowance can be bound;
Other types of people cannot be bound and do not meet the binding conditions.
(5) Whether the agency code exists when reading the agency code base of the community health point;
(6) Whether medical institutions are disabled when reading the code base of community health centers;
(7) Judge whether the company binding information is being used by other users, please try again later;
(8) Whether the unit binding point is the same as the current social welfare institution (if it is the same, it will not be handled)
If the binding conditions are not met, pressing the "OK" key will prompt the following error message!
◇ The code of this social health center does not exist, and the binding relationship cannot be established!
◇ This social health center is not qualified for binding, and the binding relationship cannot be established!
◇ The original binding record has been locked and cannot be changed temporarily. Please try again later!
◇ There is a medical insurance payment record this month, please go through the formalities of changing the binding next month.
◇ The medical insurance premium has not been paid, and a new binding relationship cannot be established.
◇ The enrollment file does not exist!
◇ The insured has surrendered, and the medical insurance relationship is terminated!
◇ This person is not the insured of hospitalization medical insurance, and a new binding relationship cannot be established!
◇ The protection card has been reported lost, so it cannot be used temporarily!
The insured does not need to establish a personal binding relationship!
2. Enterprise employees who have opened the "Authorized Individual Binding Community Health Center" can personally bind the community health center. See point 3 for details.
Third, the constraints of employers who authorize personal constraints.
It means that the whole enterprise has bound a community health point, and employees can go to other community health points for personal binding. Employees who are not bound by individuals still go to the community health point where the enterprise was originally bound.
(A) the principle of acceptance
1. The enterprise has branches (branches) or works in different places in the city.
2. Enterprises have more employees.
3. The number of medical and work-related injuries insured is the same.
4 enterprises to apply for the establishment of "authorized individual binding community health center", must choose a community health center nearby.
(2) Accepting institutions
Collection department of territorial social security institutions.
(three) to accept the materials to be provided and review them.
1. Receive the written application report of the enterprise, including the full name of the company, the company number, the number of participants, the distribution, the problems and needs encountered in the process of seeking medical treatment, and affix the official seal of the company.
2. Check the business license of the employee's workplace (note: if there is no business license, the enterprise shall provide the business license of the headquarters and the lease contract for the use of the scattered workplace) and obtain a copy of the business license.
3. The original and photocopy of the inspector's ID card.
(4) Acceptance organization
The logo of "Authorized Individual Binding Community Health Center" for the insured enterprises is unified in the collection office of the Municipal Bureau. The collection department of each branch and the social security station specifically accept the application and data review of the insured enterprises within their respective jurisdictions. After the preliminary examination, the qualified enterprises will be reported to the leaders in charge of the branch for approval, and the branch will submit it to the collection office for confirmation.
(5) Commitment period
1, 15 (including 15) applies for accreditation one month before 19, and the employees of the enterprise will be bound to the nearest community health center at the workplace the next month. 1 takes effect; If the application is made after 15, it will take effect on 1 next month.
2. Once the "Authorized Individual Binding Community Health Center" is opened, the collection office will inform all the collection departments, and then the collection departments will inform the enterprises that their employees can personally bind to the nearest designated community health center with medical insurance cards before 19 every month. Employees who are not bound by individuals will still see a doctor in the designated community health center originally bound by the enterprise.
(six) there are procedures for the insured personnel of the employer to choose the community health center in their personal capacity.
1. After checking the ID card and medical insurance card of the insured, the staff of the community health center verifies that the ID card is consistent with the medical insurance card, and logs into the online medical insurance standardized information system (http://61.144.253.93/hiiss _ yyweb/login.jsp) for hospitalization management-
2.(2) The social health center logs into the online medical insurance standardized information system-basic management-personal binding, reads the medical insurance card and submits it to complete the selected social health.
Fourth, requirements
(a) the designated medical insurance center for migrant workers shall not refuse to bind enterprises or individuals (including the insured) to apply for hospitalization medical insurance. The designated medical institutions of medical insurance for migrant workers in this Municipality must provide quality services for the insured enterprises and insured persons, including bundling work.
(2) Designated medical institutions should strengthen the training of operators of "selected community health centers", and the operators must be clear about what belongs to the unit binding business and what belongs to the individual binding business, so as to keep a clear head and operate accurately.
(III) Those who fail to handle the bundling operation according to the regulations, resulting in vicious consequences, shall be regarded as violating the rules, and be given a warning, informed criticism, suspension or cancellation of the fixed-point qualification treatment according to the seriousness of the case. At the end of the year, a 5% late fee linked to the quality of medical services shall be deducted.
(four) before 19 every month is the time to choose or change the community health service center.
(5) Where other provisions are inconsistent with these Provisions, these Provisions shall prevail.