DaXingAnLing direct settlement policy for foreign medical treatment
Through a series of publicity, the insured have a better understanding of the policy of direct settlement for foreign medical treatment, in order to really do "not ask for help", so that "the people run less legs, information run more road", the following is my carefully collated, welcome to read and collect. ", the following is my carefully organized Daxinganling direct settlement policy, welcome to read and collect.
Daxing'anling direct settlement policy for medical treatment in other places Part 1
Chapter I General Provisions
Article 1 in order to standardize the behavior of urban basic medical insurance for relocation, out-of-area referrals to medical treatment, and to ensure the rational use of the basic medical insurance fund, in accordance with the "on the issuance of the Daxing'anling region of urban basic medical insurance district-level co-ordination and urban residents of the major disease Medical insurance implementation program on the issuance of "notice" (Dazhonganling Office [20xx] No. 52) of the relevant provisions, combined with the actual work of medical insurance, the formulation of this approach.
Article II Scope of application.
(A) relocation for medical treatment.
1, participate in the basic medical insurance for urban workers retirees (including those who handle the internal retirement procedures), flexible employment participants and long-term residents living outside due to illness.
2. Participants in the basic medical insurance for urban residents who live in a different place for a long time.
(2) Out-of-area referrals. All insured persons who participate in the basic medical insurance for urban workers and basic medical insurance for urban residents.
Chapter II of the management of medical treatment in a different place
Article III handling procedures.
(a) apply for relocation for medical treatment, by the individual or the agent to the medical insurance bureau of the place of enrollment for examination, registration and filing.
(b) for the need to fill out the "Daxinganling region basic medical insurance relocation personnel declaration and approval form", this form in duplicate, the applicant, the agency to store a copy. In accordance with the principle of convenience and proximity, the insured person should choose three state-owned comprehensive medical institutions (second class and above) that are designated for medical insurance in the place of resettlement, and the medical institutions and medical organizations in the place of resettlement should agree and confirm the seal.
(C) Materials to be provided for processing:
1. Social security card and a copy of ID card;
2. Urban residents' basic medical insurance enrollees are also provided with a copy of the payment record.
3. Participants who are resettled in other places should provide the original household register of the place where they are resettled, a copy of the first page of the household register and the page of the person, or the original and a copy of the certificate of the ownership of the house of the person (if it is the certificate of the ownership of the house of a family member or a relative, the original of the certificate of the relevant relationship must be provided), or the original and a copy of the certificate of the person's residence issued by the police station and the neighborhood committee of the place where he or she is resettled;
(4) After reviewing and approving the case by the (d) After examination and approval by the Medical Insurance Bureau, the applicants who are eligible for relocation will be included in the management of medical treatment for relocation and the electronic files of relocated personnel will be established.
Article 4: Persons who are included in the management of relocation for medical treatment shall enjoy the treatment of relocation for medical treatment from the next day after the date of approval, and the selected medical institution shall not be changed within one year (12 months) after the selection. Once the medical institution is selected, it cannot be changed within one year (12 months). If the medical institution needs to be changed after one year (12 months), it must be re-registered according to the above requirements. To cancel the relocation of medical treatment, you need to provide a copy of the identity card of the person and the agent.
Article V medical procedures.
(a) included in the management of relocation for medical treatment, must be in the selected medical institutions. Handling of relocation for medical treatment before the emergency occurred in the place of relocation and has enjoyed the relocation of medical treatment personnel in the non-relocation of the emergency occurred, according to the management of out-of-area emergency medical treatment.
(2) If the persons who are entitled to the medical treatment of relocation need to be referred to hospitals for treatment due to illness, they should be referred to the higher-level medical institutions or specialized hospitals by the designated medical institutions at the highest level selected by them, and the designated medical institutions should issue the referral formalities, and the starting standard and write-off ratio of the referral should be implemented in accordance with the standard of the referral out of the region; for the medical expenses incurred by those who do not go through the referral formalities according to the above stipulations, the co-ordination fund will write off 50% of the expenses within the policy write-off range according to the standard of the referral out of the region. The medical expenses incurred without the above referral procedures shall be written off by the integrated fund within 50% of the policy; medical expenses incurred for infectious diseases or mental illnesses referred to state-owned specialized hospitals in the same city as the place of resettlement shall be written off in accordance with the policy of intra-regional referral.
(C) enjoy the relocation of medical treatment personnel by the regional outpatient special chronic disease expert consultation recognized that meets the criteria for inclusion in the management of outpatient special chronic disease, in the resettlement of state-owned hospitals in line with the indications of outpatient special chronic disease of the medical expenses, the basic medical insurance fund in accordance with the regional management of outpatient special illnesses and the proportion of the payment of the write-off.
Article VI settlement procedures.
(a) enjoy the relocation (outside the Daxinganling area) medical treatment personnel incurred medical expenses, in accordance with the "Heilongjiang Province urban workers basic medical insurance drug catalog", "diagnosis and treatment catalog", "medical services and facilities range and payment standards" and the region of the basic medical insurance of the relevant policies and regulations for the review, the basic medical insurance co-ordination fund payment ratio according to the region of the proportion of the write-off is reduced by 5 percentage points implementation.
(b) The medical expenses incurred by insured persons enjoying the treatment of relocation for medical treatment in designated medical institutions within the scope of payment by the basic medical insurance co-ordination fund can be settled directly with the social security card in cities that have carried out the networked settlement of medical expenses for relocation for medical treatment; in cities that have not carried out the networked settlement of medical expenses for relocation for medical treatment, the medical expenses will first be advanced by the individuals, and then, upon completion of the treatment, they will be settled directly with the discharge summary or diagnosis, receipt of medical expenses, and the certificate of the medical expenses. When the treatment is finished, the individual will be reimbursed with the hospital discharge summary or diagnosis, medical fee receipts, a summary list of medical fees and a copy of the medical record at the local office of the insured for examination and reimbursement.
(3) The person who enjoys the treatment of relocation can take the outpatient and pharmacy bills to the agency for card verification.
Chapter III referral management
Article 7 of the region's basic medical insurance co-ordination, the insured person can independently choose the region's state-owned hospitals, do not need to apply for referral procedures.
Article 8 out-of-region referral conditions.
(a) regional medical institutions do not have sufficient conditions for diagnosis and treatment of acute and critical patients;
(b) the condition requires and regional medical institutions do not have the equipment or technology to carry out the examination and treatment program.
Article IX local referral procedures.
(a) the implementation of out-of-area referrals level by level, counterparts, fixed-point referrals, from the regional hospitals, regional hospitals for referrals to fixed-point hospitals outside of the region related procedures. Meet the referral conditions of the local level insured persons, by the attending physician to fill out the "patient referral form", signed by the section chief, the Medical Office of the audit seal, to the regional health insurance bureau for the record and registration, referred to the out-of-area fixed-point hospitals for treatment.
(B) the insured person in the province after the designated hospital, due to hospital technology, equipment, treatment means and other conditions, need to be transferred to hospitals outside the province for further treatment. The hospital must provide a certificate of referral and transfer with official seal. When reimbursing the medical expenses, provide the relevant reimbursement materials and the referral certificate of the hospital outside the region.
(C) regional hospitals, regional hospitals do not have the conditions for treatment of acute, critical and serious cases, there is a need to be transferred to the provincial hospitals or hospitals outside the province over the level of medical treatment (hospital director's signature is required), can be transferred to foreign medical treatment, but it must be transferred to the regional health insurance bureau within three working days after the transfer of the above procedures to make up for the transfer of hospital procedures.
Article 10 of the county (district), the Forestry Bureau insured persons (urban workers, urban residents) referral for medical treatment by the participants of the local health insurance bureau to manage their own.
Article 11 of the region's designated medical institutions have the obligation and responsibility to implement the relevant provisions of the system of hierarchical diagnosis and treatment, medical institutions diagnosis and treatment of patients within the scope of the principle of not transferring patients should be strictly in accordance with the conditions of referral and referral procedures for examination and approval of the gatekeeper. If you do need to be transferred, the designated medical institution must promptly handle the referral procedures for the insured person, and is obliged to inform the patient and his family to register with the medical insurance bureau of the insured place for the record before transferring to the hospital.
Article 12 of the approved referral for medical treatment, the patient or his family must take the initiative to the transfer hospital to show the relevant referral certificate. The approval of the field referral time is valid for a maximum of one month, not within the validity period of the consultation, you must go to the participating local health insurance bureau for extension procedures. The transfer procedures are limited to a clinic effective, a clinic period can not exceed 60 days, the seriousness of the condition needs to be extended, with the hospitalization summary and diagnosis of the disease, to the participating medical insurance bureau to apply for an extension of the procedures.
Article 13 Settlement and Reimbursement.
(a) In cities that have carried out networked settlement of medical fees for medical treatment in other places, social security cards can be used to settle medical fees directly.
(2) In cities that have not carried out the network settlement of medical fees for medical treatment in other places, the medical fees will be advanced by the individual first, and after the treatment is completed, the medical fees will be reimbursed by the medical insurance bureau of the insured place with the introduction letter of the transfer, discharge summary or diagnosis, medical fee receipts, the summary list of the medical fees, and the copy of the medical records.
In principle, participants are not allowed to take medicines with them when they are discharged from the hospital. If they do need to take oral medicines, they can only take medicines related to their illnesses, 7 days' dosage for acute illnesses, 15 days' dosage for chronic illnesses, and 1 month's dosage for special illnesses, and the types of medicines should not exceed 4 types, and should not be beyond the range of medicines for the first diagnosed illnesses, and should not be accompanied by examinations and diagnostic and therapeutic items.
(C) out-of-area referral patients after the end of the referral treatment, the need for a specified period of time (a treatment cycle, in principle, not more than one year) multiple continuation of treatment or review of hospitalization, there must be a clear opinion of the transferring hospital in writing, and by the participants of the medical insurance bureau for approval and consent.
(d) The hospitalization medical expenses that are in line with the scope of payment of basic medical insurance will be paid by the integrated fund according to the regulations after the approval of the transfer to the higher designated hospital. Without the approval of the transfer of overseas treatment, the integrated fund in accordance with the policy within the scope of 50% write-off.
Chapter IV Supplementary Provisions
Article 14 of the urban basic medical insurance relocation, referral medical expenses in principle, the year settled. There are special circumstances that medical expenses are not reimbursed in that year, according to the time of discharge, not later than 12 months, more than 12 months without reimbursement procedures, as I automatically give up the hospitalization of health insurance treatment.
Article 15 of the referral treatment across the health insurance business year, according to the time of discharge belongs to the health insurance year reimbursement policy settlement.
Article 16 of this approach by the Daxinganling Human Resources and Social Security Bureau is responsible for interpretation.
Article 17 of these measures shall come into force on the date of publication. Previous documents inconsistent with the provisions of these Measures, these Measures shall prevail.
Extended reading
Direct settlement of foreign medical treatment in the end
In the past, to visit the foreign medical treatment, the insured person has to advance their own medical expenses, and then return to the place of reimbursement. Now such a thing has become history for the people of Daxinganling. From the beginning of 20xx, the local level of our region has been realized Harbin designated hospitals for direct settlement of medical treatment in other places. 20xx June, the work of this step, our region fully realized Harbin designated hospitals for direct settlement of medical treatment in other places, for the majority of the region's insured and designated medical institutions to provide a more convenient and fast settlement service of medical insurance. However, what hospitals in the province to our region can be directly settled medical insurance participants? To go to the other side of the medical need what procedures and formalities?20xx December 9, the reporter came to the regional health insurance bureau, regional health insurance bureau deputy director Yang Zhihong on the relevant issues for everyone to carry out a detailed introduction.
Yang Zhihong said, Daxinganling region is the province's first province to open the direct settlement of the city (place), currently under the jurisdiction of the three counties and four districts of the five Forestry Bureau has been fully realized in the province of designated hospitals in the direct settlement of the direct settlement of the medical treatment, which not only reduces the patient's advances in the pressure of the funds, but also eliminates the need to go back and forth to reimbursement of the medical expenses of the trouble, and greatly facilitates the participation in the medical care of the people. As of the end of December 20xx, the direct settlement of our region has reached 1251 people, settlement funds amounted to 10.91 million yuan.
Direct settlement of fixed-point hospitals
At present, the region's participants in the hospitalization of direct settlement of fixed-point hospitals *** there are 20: the first hospital attached to Harbin Medical University, Harbin Medical University attached to the second hospital, Harbin Medical University attached to the third hospital (the province of oncology), the fourth hospital attached to Harbin Medical University, the hospital, Heilongjiang Province hospital (South China), the hospital, the hospital, the hospital, the hospital, the hospital, the hospital, the hospital, the hospital, and the hospital, the hospital. Hospital, Heilongjiang Provincial Hospital (Nangang, Xiangfang), the People's Liberation Army 211 Hospital, Heilongjiang Zhongde Orthopaedic Hospital, Heilongjiang Provincial Hospital of Traditional Chinese Medicine (Provincial Zuyan), Heilongjiang Provincial University of Traditional Chinese Medicine Affiliated Hospital No. 1, Heilongjiang Provincial University of Traditional Chinese Medicine Affiliated Hospital No. 2 for the first batch of direct settlement of the region's first 10 different places for medical treatment fixed point medical institutions. 20xx December, in order to further broaden the insured persons to seek medical care In December 20xx, in order to further broaden the scope of medical treatment for the insured, on the basis of taking into account the comprehensive and specialized, traditional Chinese medicine and western medicine hospitals, our region also added Heilongjiang Infectious Disease Prevention and Control Hospital, Heilongjiang Nongken General Hospital, Heilongjiang Far East Cardiovascular and Cerebral Vascular Hospital, the first specialized hospital in Harbin, Harbin First Hospital, Harbin Chest Hospital, Harbin Children's Hospital, Hainan Nongken Sanya Hospital, Sanya People's Hospital, Sanya Traditional Chinese Medicine Hospital and other hospitals as the first 10 medical institutions for medical treatment in different places in our region. hospitals for our region's direct settlement of medical treatment in other places designated medical institutions. Among them, Hainan Provincial Agricultural Reclamation Sanya Hospital, Sanya City People's Hospital, Sanya City Hospital of Chinese medicine 3 hospitals for our region of the direct settlement of personnel direct point of care medical institutions.
Procedures to be carried out in the insured place
The local level of the insured person needs to be referred to, first of all, go to the local level of the hospital (regional hospitals or regional hospitals) of the relevant departments to issue a patient referral order, and in the referral order to be stamped on the hospital's medical department (the regional hospitals for the Office of the Medical Insurance) official seal. Then, the insured person with the referral order to the regional health insurance bureau registration record can enjoy the direct settlement of medical services.
After a participant registers for a referral at the medical insurance bureau, the medical insurance card can only be used at the designated hospital of the referral, and the system will automatically transfer it back to the place of participation after the settlement. The referral is valid for one month. If you don't go to the designated hospital for settlement, you can notify the health insurance bureau of your place of residence by phone to transfer back to your place of residence.
In order to facilitate the county (district), the Forestry Bureau participants in foreign medical treatment, the region to take the localized management approach, that is, the county (district), the Forestry Bureau of Health Insurance Bureau (Section) can be based on the needs of the participant's condition directly referral to the provincial designated hospitals without the need to go to the regional health insurance bureau for referral procedures.
It should be noted that the referral order issued by the designated hospitals, participants can only go to which hospital settlement, with the uniqueness of the participants in the hospital before, if you want to change another designated hospital, you can contact with the participation of the local health insurance bureau to change.
Daxing'anling Direct Settlement Policy Part 2
How to Settle? Through the direct settlement system of the province, the medical expenses incurred for medical treatment in other places will be settled directly according to the policy standards of the place of participation, and the participants only need to pay the individual co-payment and out-of-pocket expenses; the expenses to be paid or reimbursed by the individual account and the integrated fund will be recorded on the card.
The scope of the direct settlement of medical fees for participants in different medical treatment (basic medical insurance drug catalog, medical service facilities catalog, diagnostic and treatment items catalog including consumables, hereinafter referred to as the "three catalogs"), the implementation of medical projects in accordance with the place of medical treatment for the time being, to be the province, "three catalogs
Provincial medical treatment to be filed
Participating in the urban workers medical, maternity insurance personnel, participating in the urban residents of the medical insurance personnel, the implementation of the medical fee reimbursement or medical fee co-ordination of the retirees, the implementation of the medical fee reimbursement of the 6 and above the disabled soldiers, are all belong to the scope of direct settlement of the medical treatment of the different places.
However, Hebei Province will start the policy of direct settlement of medical insurance for medical treatment in other places first, and when the conditions are ripe, it will gradually include the maternity insurance, the retired persons who have paid the actual medical fees or the medical fee co-ordination, and the disabled military personnel who have paid the actual medical fees, and the military personnel who have been disabled in grade 6 and above in the scope of the direct settlement of medical treatment in other places, and will implement it in accordance with the relevant provisions of the Regulation.
The insured persons who need to seek medical treatment in other places may encounter two situations: long-term or temporary across the integrated area within the province.
The insured persons who need to seek medical treatment in a different place for a long period of time refer to those who are resettled in a different place and reside there for a year or more, and those who work in a different place for a long period of time for one year or more due to their work needs and who need to seek medical treatment and purchase medicines across municipal co-ordination zones in the province.
Temporary foreign medical participants, refers to the participants who need to be referred to higher-level medical institutions for treatment (hereinafter referred to as referral) due to the limitations of the medical conditions in the place of participation, and the participants who need to be temporarily treated across the integrated area of the province due to a sudden illness (emergency rescue diseases) during business trips, study, training, or visits to relatives (hereinafter referred to as emergency treatment).
Participants in the province across the integrated area of the medical treatment, should be in advance to the participating medical insurance agency (hereinafter referred to as the agency) for the registration of medical treatment in a different place for the record. The first thing you need to do is to get your hands on a new pair of shoes or boots, and you'll be able to get your hands on a new pair of shoes or boots that you want to wear.
The policy of cross-provincial medical treatment is still implemented in accordance with the original policy
Participants only need to pay for personal out-of-pocket expenses and out-of-pocket expenses, then how to settle the other medical expenses? That's the settlement between the provincial health insurance center and the coordinating district agencies. Each coordinating district agency should strictly follow the amount of settlement of medical fees for medical treatment in other places by the provincial medical insurance center, and do the fund clearing and allocation work in a timely manner, and shall not increase or decrease the expenditure items, raise or lower the payment standard for any reasons. For the settlement of medical fees in a different place in the reconciliation of errors, outstanding accounts and other issues, by the co-ordination of the regional agencies to report to the provincial health insurance center in a timely manner to coordinate and deal with.
The problem of direct settlement of the provincial medical treatment is solved, what about the cross-provincial medical treatment? The relevant person in charge of the provincial human resources and social welfare department said that before the implementation of the policy of direct settlement of cross-provincial medical treatment, cross-coordinated area to the outpatient medical institutions in foreign provinces, hospitalization, foreign designated pharmacies to buy drugs, threw according to the implementation of the original policy around the original policy; cross-provincial direct settlement of cross-provincial medical settlement policy after the implementation of the direct settlement of the direct settlement of medical treatment with the foreign province involved in the direct settlement of the protocols are separately stipulated.
Extended reading
Beijing and Hebei take the lead in realizing the direct settlement of foreign medical insurance
冀医保直接结算服务协议签约仪式在河北燕达医院举行，同时河北燕达医院开通全国首个异地结算系统。 Beijing and Hebei are the first in the country to realize the direct settlement of medical treatment in other places.
Jiang Zhongtao, a retired employee of China Construction Engineering Corporation (CECC), became the first beneficiary of the Beijing-Hebei direct settlement system after the opening of the system. This morning, he took his Beijing health insurance card to Yanda Hospital in Yanjiao, Hebei, and successfully registered, consulted, took medication, and settled the bill.
Jiang Zhongtao said, he lives in Yanjiao, Hebei Province, to participate in the Beijing health insurance, "before they have to advance 100% of the cost of medicine and then submit the bills to the unit, the unit and then uniformly handed over to the Social Security Bureau, the time at least one or two months, now it's too convenient, directly swipe the card, only 10% of the cost of their own burden."
According to statistics, in Hebei Yanjiao resident population in Beijing insured persons amounted to 350,000, in order to solve the Beijing, Hebei medical insurance in the two places in the overall level, reimbursement standards, price items and charges bills and other aspects of the differences, the two social security departments after 10 months of close cooperation in the country's first realization of the direct settlement of medical treatment, but also for the support of the Beijing Chaoyang, Tiantan and other hospitals and Yanda Hospital The two social security departments have worked closely together for 10 months to realize the first direct settlement of different medical treatment in China.
The picture shows that after the opening of the Beijing-Hebei health insurance direct settlement system, Jiang Zhongtao, an old man with a Beijing health insurance card in Yanda Hospital in Yanjiao, Hebei Province, successfully registered, medical treatment, medicine and settlement. Song Mintao photo
Beijing Municipal Bureau of Human Resources and Social Security Deputy Inspector Xu Renzhong said, this is the implementation of the national Beijing-Tianjin-Hebei coordinated development of a major strategy of an important initiative, but also the Beijing Municipal Government and the Hebei Provincial Government to promote the public **** service resources, improve the level of service, in particular, the advantages of a complementary measure. Beijing's Chaoyang Hospital, Beijing Hospital of Traditional Chinese Medicine, Beijing Tiantan Hospital and other high-quality health care resources have also carried out a number of cooperation agreements with Yanda Hospital, and the cross-location settlement not only facilitates Beijing insured persons residing in Hebei, but also serves as a focus point for promoting the public ****service ****construction ****enjoyment, and promotes the development of high-quality medical and health care resources in Beijing to the outside of the capital through the cooperation of running a medical clinic and other ways, and is a part of the national plan for the coordinated development of the Beijing-Tianjin-Hebei region. The specific requirements of the National Beijing-Tianjin-Hebei Cooperative Development Plan in the evacuation of medical and other social public **** service functions.
Liu Lianjie, deputy secretary of the Hebei Sanhe Municipal Party Committee and acting mayor of Sanhe, said that Sanhe, located at the eastern gate of Beijing, is striving to be the first on the road to build the Beijing-Tianjin-Hebei Cooperative Development Pilot Demonstration Area, and Beijing has achieved fruitful results in the docking of transportation, health care and other fields. This time, Beijing medical insurance in Yanda hospital to realize direct settlement with a card, is to serve the people's livelihood, benefit the people of a good thing, is Beijing and Hebei in the field of synergistic development of public **** services an important step forward, is the result of the two governments, departments, enterprises **** with the difficulties.
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