1, on-site filing: foreign medical personnel with their own identity cards, social security cards and related materials (foreign household registration or foreign residence permit or referral qualification of the participating medical institutions issued by the medical institutions outside the transfer of medical care, etc.) to the front desk of the participating agencies. If you have a representative, you need to bring the representative's ID card.
2. Online filing: The insured persons (except Huaian insured persons) can log in the mobile APP of the insured place and the municipal governmental affairs website, enter information and upload relevant materials according to the prompts, and complete the filing after being audited and approved.
The scope of people seeking medical treatment in other places:
Four categories of people participating in the basic medical insurance for urban workers or urban and rural residents:
1. Retirees resettled in other places;
2. Long-term residents living in other places;
3. Permanent staff members residing in other places;
4. Referrals from other places.
Steps of medical treatment in a different place:
Filing first - selecting the place of medical treatment - holding the card for medical treatment, one of the three steps is indispensable.
1. First record. That is, before the medical treatment in a different place, you should first in the insured place of the agency (referral hospital) for the record of medical treatment in a different place.
2. Choose the place of medical treatment. That is, select the coordinating area of the place of medical treatment (generally municipal coordinating area, Beijing, Tianjin, Shanghai, Chongqing and Hainan, Tibet and other six provinces and municipalities directly to the corresponding provinces and municipalities for the record).
3. card. That is, the social security card should be presented at the time of admission procedures.
The process of filing for medical treatment in a different place:
Long-term residence in a different place:
Required materials: retirees resettled in a different place, long-term residents in a different place, permanent staff in a different place can be based on the public security department of the place of medical treatment issued by the residence permit, residence permit receipt, proof of residence in the community, the real estate certificate of the place of my medical treatment, the place of my medical treatment, the hukou, etc., can be issued by the unit where they work or study can apply for a certificate of residence. If you are working or studying abroad, you can get a certificate issued by your organization.
Processing channels: health insurance office window, Jiangsu government network Lianyungang flagship store, telephone fax, "my Lianyungang" cell phone APP.
Out-of-town referral:
Transferring out of the city hospitalization:
Transferring out of the city hospitalization can be uploaded directly through the local tertiary hospitals agreed to record, for the following eight categories of diseases by the tertiary hospitals to clearly diagnose, the participants can not be related to the hospitals, but also can be used for the hospitals. After the diagnosis, the insured person can go to the service window of the medical insurance agency with the relevant materials (pathology report, laboratory test, imaging data, discharge summary, etc.) to directly handle the referral filing procedures.
The catalog of these eight categories is as follows: 1, surgical treatment of malignant tumors with a clear diagnosis; 2, chemotherapy for leukemia; 3, organ (bone marrow) transplantation; 4, interventional and surgical treatment of heart valve disease; 5, thoracic and abdominal aortic aneurysm and aortic coarctation surgical treatment; 6, surgical treatment of knee replacement; 7, orthopedic treatment of spinal deformities (scoliosis); 8, congenital heart disease of children Surgical treatment.
How to settle the medical expenses for medical treatment in other places:
The "catalog of the place of participation, policy of the place of participation" is adopted for medical treatment in other places within the province, and the "catalog of the place of participation, policy of the place of participation" is adopted for medical treatment in other places across the province.
The outpatient "one-stop" settlement (outpatient specific items, outpatient chronic diseases, outpatient coordination) and general inpatient hospitalization have been opened for outpatient medical treatment in different places within the province. In addition to the Yangtze River Delta region, only general hospitalization settlement is available for cross-provincial medical treatment.
How to reimburse medical expenses manually:
Manual reimbursement is limited to medical expenses incurred in emergency treatment in other places, non-networked settlement in the place of filing after filing in other places, as well as medical expenses incurred in other places without filing in other places.
For those who are hospitalized for emergency treatment in a foreign place due to their medical condition, or those who are hospitalized in a non-networked settlement in the place of filing, they can provide emergency medical records, hospitalization invoices, stamped cost details, and discharge summary/diagnostic certificates, and go to the window of the medical insurance office or through the Jiangsu government affairs network to apply for manual reimbursement.
The time for manual sporadic reimbursement is no more than 10 working days in principle, and no more than 20 days in special cases.
The "two types of people" medical reserve case system:
1, the scope of the reserve case: participate in the Lianyungang City urban workers' basic medical insurance or urban and rural residents' basic medical insurance, and normal enjoyment of medical insurance treatment of the migrant workers and go to a different place of employment and entrepreneurship (hereinafter referred to as the two types of people).
2, the two types of people can be through the health insurance office window, Jiangsu government service network to fill out the "" two types of people in a different place for medical pre-approval of the record form ", and within a certain period of time, by telephone fax, government network and other channels to the insured place of the health insurance agency to make up for the relevant filing information can be completed in a different place to record medical care.
3. The two categories of people who have handled the preparatory case can enjoy the relevant treatment from the date of the approval of the preparatory case after the formal filing is approved.
Query channels for the record of medical treatment in a different place and the opening of hospitals in a different place:
Participants can log on to the information query system () of the national health insurance network to obtain information related to medical treatment in a different place, including the designated medical institutions in a different place, the registration and filing of the insured persons, the medical treatment agencies in a different place, and the opening of the medical treatment cost and integrated area information query in a different place across the provinces, and so on. Those who have completed the filing in the insured place can register on the website, and after completing the real-name verification, they can inquire about their registration and settlement information of medical treatment in other places online.
What should I do if the direct settlement for medical treatment in other places is unsuccessful?
The national platform has set up an error-reporting contact handling mechanism and a system emergency handling mechanism to respond to problems at any time. If a person with a different medical care card makes a mistake when going through hospitalization procedures or settling expenses, the first thing to do is to confirm whether the person has successfully filed for the record, and whether the hospital is a designated medical institution with a network in a different place. If the above two points have been completed and still cannot be settled, the staff of the medical insurance office of the medical institution in the place of medical treatment can help contact the medical insurance agency in the place of medical treatment to investigate and solve the relevant problems. Indeed, due to various reasons can not be network settlement, can be converted to cash treatment, after discharge in accordance with the relevant provisions of the insured place to implement piecemeal reimbursement.
The process of medical treatment for foreigners living in Lian:
For foreigners living in Lian, you only need to apply for the record of foreign medical treatment in your place of insurance, and you don't need to go to the window of Lianyungang City Health Insurance for landing procedures, the system will automatically download the information of the people living in Lian at regular intervals, and the foreigners living in Lian can go to the city's foreign hospitals directly with the card to get medical treatment on their own.
Legal basis:
Article 5 of the Regulations of the People's Republic of China on Basic Medical Insurance for Urban Employees
Basic medical insurance is in principle coordinated by cities, counties and autonomous counties, and is managed on a territorial basis.
Article 39 of the Regulations of the People's Republic of China on Basic Medical Insurance for Urban Workers
If the social insurance agency approves treatment at a medical institution in a different place, and if the retiree has resided in a different place for more than one year, his/her basic medical insurance treatment shall be carried out in accordance with these Regulations.