Hospitalization deposit: when the insured person is hospitalized in a designated medical institution, the hospital may charge a certain amount of deposit according to the different diseases, but it shall not exceed the personal conceit. When leaving the hospital for settlement, refund more and make up less.
Hospital responsibility: during the insured's hospitalization, the designated medical institution shall provide the patient with a detailed list of expenses. Patients should be informed in advance of the use of class B drugs and the treatment items paid by individuals. If the bed fee exceeds the standard, the fees other than the "three catalogues" must be agreed by the insured.
Discharge settlement: When the insured person is discharged from the hospital, he should settle the individual pays part with the designated medical institution in time. Designated medical institutions should print receipts and settlement lists.
Take medicine after discharge: the insured person is generally not allowed to take medicine when he leaves the hospital. If it is really necessary to take medicine, designated medical institutions should strictly control it, generally not more than seven days.
Referral and transfer
1. Local referral and transfer: If the hospital has difficulties in diagnosis and treatment due to equipment or technical limitations, it needs to be transferred according to regulations. When the insured person is transferred to a higher-level hospital, the difference between Qifubiaozhun and Qifubiaozhun should be filled. After the end of medical treatment, the expenses transferred out and into the hospital are merged into one hospitalization expense settlement.
2. Referral and off-site referral: If the conditions for referral and referral are met, the designated medical institutions of Grade III and Grade A can conduct expert consultation in specialized hospitals above the municipal level and make suggestions. The medical insurance management department of the hospital shall fill in the Record Form of Medical Insurance Referral for Urban Workers in Jinan City and report it to the medical insurance agency for examination and approval.
Conditions for off-site referral:
(1) The city is limited to critical and difficult diseases that cannot be treated by technical and equipment conditions;
(2) without the city's three designated medical institutions or above the municipal level specialized hospitals for examination and expert consultation;
③ The level of diagnosis and treatment in the receiving hospital is higher than that in this city.
When the insured person really needs to be referred for diagnosis and treatment in different places, it should be approved by the municipal third-class A-level designated general hospital or the designated specialized hospital above the municipal level, fill out the "Jinan Urban Workers' Medical Insurance Insured Person Referral and Referral Filing Form" and report it to the medical insurance agency for the record. If it is really necessary to refer the case after verification, it shall be signed by the leader for the record.
How to reimburse medical insurance hospitalization? Medical procedures of the insured under several special circumstances:
1. Resettlement in different places: When the insured person is hospitalized in different places, he should seek medical treatment in the designated hospital for filing. After the change of the designated hospital, the insured unit shall go through the formalities of change at the medical insurance agency in time.
2. Long-term overseas: When the insured who has been overseas for a long time is hospitalized, he should seek medical treatment in the designated hospital for filing. After the change of the designated hospital, the insured unit shall go through the change formalities at the medical insurance agency in time; When the insured person returns to work locally, he should also go through the formalities of identity change in time.
3. Suspension from school: If the insured is hospitalized during suspension from school, he must report to his unit within three working days after admission, and the handling personnel of his unit shall immediately go through the registration formalities at the medical insurance agency.
4. Non-designated emergency hospitalization: When the insured is hospitalized in a non-designated hospital in this city due to critical illness, he/she must go through the registration formalities at the medical insurance agency within three days from the date of hospitalization, with a copy of the outpatient rescue medical record, a checklist and a diagnosis certificate from the attending doctor. Failing to report or verifying that it is not an emergency rescue for critically ill patients without justifiable reasons, the overall fund will not pay, and it will be transferred to designated medical institutions for treatment after the illness permits.
5. The insured on the grey list is hospitalized: the insured is hospitalized after the company owes money, and the credit card system automatically determines it as a grey list. In this state, the designated medical institutions should still implement the insured's basic medical insurance policy, and the medical information should also be uploaded to the core end, but at the time of discharge settlement, the medical expenses will all be borne by the individual.
If the payment status is normal at the time of admission, but the credit card system determines it as a gray list at the time of discharge, the settlement procedure is the same as above.
In addition: (1) The insured person was admitted to the hospital without a card.
When the insured person is admitted to the hospital without a card, he should go through the formalities of reporting the loss and replacing the card in time, and register at the audit settlement place. After the relevant certificates are issued in one place, the insured shall be handed over to the medical insurance management department of the hospital where he lives in time, and the medical insurance management department shall notify his competent doctor and relevant personnel to implement the basic medical insurance policy for the insured during his hospitalization. After the card is reissued, it will be re-registered in the hospital where you live.
(2) The insured has no card when he leaves the hospital.
When the insured person leaves the hospital without a card, the hospital should ask the insured person to pay the hospitalization expenses in advance, not settle the account temporarily, and return to the hospital for settlement after the card is reissued.
(3) Repeated hospitalization
When the same disease needs to be hospitalized again within 0/5 days after discharge/KLOC-,the unit manager shall carry the insured person's latest discharge diagnosis certificate, outpatient medical record and relevant diagnosis certificate signed by the attending physician and stamped by the hospital, and go through the registration formalities at the audit settlement place.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.