City security personnel
The city, district and county medical insurance center to which the insured unit belongs informs the unit to receive the Medical Insurance Card for its employees. When the insured unit receives it, it shall carry the Notice of Receiving Social Security Card (Special for Medical Insurance) issued by the city, district and county medical insurance center, the letter of introduction from the unit and the ID card of the recipient, and receive the medical insurance card from the city, district and county medical insurance center to which it belongs, and then issue it to the insured.
Personal insurance personnel
When an individual employee is hospitalized for the first time after being insured for outpatient serious illness, family sickbed medical treatment or emergency observation room, he should bring the outpatient serious illness registration form (or admission notice, family sickbed construction notice) and his ID card to the neighboring county medical insurance center for medical insurance card; Pensioners should bring their ID cards to the city, district and county medical insurance centers to apply for the "Medical Insurance Card", and at the same time choose designated hospitals for outpatient and emergency services.
Fourteen, how to use the social security card (medical insurance)
1. Social security card (special for medical insurance) (hereinafter referred to as medical insurance card) is only for the insured's own use, and shall not be lent, fraudulently used, altered or forged.
2. The Medical Insurance Card shall be properly kept, and shall not be bent, folded or scratched, and shall not be exposed to magnetic objects (such as televisions, stereos and magnetic buckles). ).
3, the insured to the designated hospitals in the city, designated pharmacies dispensing (not including individual workers), or to the city, district and county medical center for medical expenses reimbursement and other medical insurance affairs, must use the medical insurance card (social security card has been issued, the insured should use the social security card).
4. If the Medical Insurance Card is not obviously damaged but can't be used, the insured can go to the nearby city, district and county medical insurance center for repair, and replace it if it can't be repaired.
5. When the medical insurance card can't be used due to equipment failure in designated hospitals or pharmacies, the medical expenses will be paid by personal cash first. After troubleshooting, the original hospital or pharmacy with equipment failure shall settle accounts again according to regulations.
6. On-the-job insured persons go abroad (border) to settle down and cancel the household registration in this city, and the medical insurance relationship is transferred out of this city. If the insured person dies, the medical insurance card should be returned to the city, district and county medical insurance center for cancellation.
15. How to report the loss of social security card (medical insurance)?
1, the phone was reported lost.
(1) If the insured loses his social security card (special for medical insurance) (hereinafter referred to as the medical insurance card), he can first call the loss reporting telephone number set up by the municipal medical insurance center (62533 197) to report the loss. When reporting the loss, the name, ID number, medical insurance card number and unit name of the lost person shall be provided.
(2) After the loss reporting telephone is immediately confirmed by the loss reporting staff, the settlement of the loss reporting telephone card shall be stopped within 1 hour. At the same time, the lost person should go through the written declaration formalities at the nearby city, district and county medical insurance center within 48 hours (that is, within 2 days, holidays will be postponed).
(3) When reporting the loss by telephone, if the information provided by the loss reporting person is incomplete or incorrect and the loss reporting person cannot be identified, the loss reporting person shall report the loss in writing in time.
2. Report the loss in writing
(1) After the insured loses his medical insurance card, he can bring his ID card to the nearby city, district and county medical insurance center to report the loss in writing in time, and go through the formalities of replacing the card at the same time. If an agent is entrusted to another person, the identity card of the entrusted person shall also be presented.
(2) The staff will immediately confirm the written report and stop the settlement of the loss reporting card within 1 hour (the telephone report has stopped).
3. Cancel the loss reporting
(1) If the insured person retrieves the medical insurance card from the telephone report to the written report, he can go to the nearby city, district and county medical insurance center to report the loss and cancel it with his medical insurance card and ID card. If an agent is entrusted to another person, the identity card of the entrusted person shall also be presented.
(2) The settlement function of the medical insurance card will be restored within 1 hour after the staff immediately confirms the loss reporting and cancellation.
4. Others
(1) Before the city, district and county medical insurance centers accept the loss report and stop the settlement of the loss report card, all economic losses caused by the loss of the medical insurance card shall be borne by the individual.
(2) Emergency medical expenses incurred during the loss reporting period of the medical insurance card (from the time when the loss is reported by telephone or in writing to the time when the medical insurance card is reissued) can be applied for sporadic reimbursement in the city, district and county medical insurance centers that accept the application for card replacement.
Sixteen, how to handle the social security card (medical insurance) card replacement (replacement), replacement card.
1, change the card
(1) The insured can report the loss of the social security card (special for medical insurance) (hereinafter referred to as the medical insurance card) at the municipal, district and county medical insurance centers, and can also apply for a replacement medical insurance card.
(2) On the third working day after applying for a replacement card, you can get a new "Medical Insurance Card" at the city, district and county medical insurance center where you apply for a replacement card.
(3) When receiving a new "Medical Insurance Card", pay a fee of 10 yuan as required.
Step 2 change the card
(1) If the medical insurance card is damaged, you can bring your ID card and the damaged medical insurance card to the nearby city, district and county medical insurance center for card replacement.
(2) The accepted city, district and county medical insurance centers will issue new medical insurance cards in time after handling the card replacement procedures, and recover the damaged medical insurance cards.
(3) When receiving a new "Medical Insurance Card", pay a fee of 10 yuan as required.
Step 3 repair the card
(1) When the medical insurance card cannot be used in hospitals and pharmacies, hospitals and pharmacies will issue a notice of damage to the medical insurance card. The insured shall carry the medical insurance card, the notice of medical card damage and my ID card within 3 days, and go to the nearby city, district and county medical insurance center for card inspection.
(2) If the card can be reissued after inspection, the original "Medical Insurance Card" will be returned to the insured by the accepted city, district and county medical insurance center for continued use.
(3) If the card cannot be reissued after inspection, the accepted city, district and county medical insurance center will issue a new medical insurance card and recover the original medical insurance card. If it belongs to the insured's improper custody, it shall pay a handling fee of ten yuan according to the regulations.
4. Others
(1) If the client entrusts others to handle the above matters, the client shall show his ID card.
(2) When the medical insurance card is damaged and can't be used, you can apply for sporadic reimbursement to the city, district and county medical insurance center within 1 month after completing the procedures for replenishing or renewing the medical insurance card.
Seventeen, how to handle the errata of social security card (medical insurance)
1, correction application
If the name and ID number of the social security card (special for medical insurance) (hereinafter referred to as the "medical insurance card") are incorrect, the insured person may bring his ID card and "medical insurance card" to the medical insurance center of the neighboring city, district and county to apply for errata. If an agent is entrusted to another person, the identity card of the entrusted person shall also be presented.
2, errata method
After accepting the application, the city, district and county medical insurance center shall make the following treatments respectively according to the contents of the application for errata:
(1) If the name or ID number on the medical insurance card is printed incorrectly, the medical insurance card shall be reissued and the original medical insurance card shall be recovered.
(2) If the words in the name belong to uncommon words, the staff shall fill in the correct name manually and return it to the insured after affixing the confirmation stamp of uncommon words.
(3) If the original information in the computer system is wrong, the following measures should be taken according to the situation:
(1) If it belongs to the old-age insurance insured in this city, it shall issue a "Notification Form for Correcting the Name and ID Number". The handling personnel of the insured unit shall go to the relevant district and county social security centers (the insured person shall be directly handed over to the district and county social security centers by himself), and after verification by the district and county social security centers, a receipt shall be issued. After receiving the receipt 15 days, the insured person or the handling personnel of his unit will bring the receipt to the original city, district and county medical insurance center to replace the new medical insurance card;
(2) do not belong to the city's old-age insurance insured, the name is wrong by the city, district, county medical insurance center after direct errata, reissue a new "medical insurance card"; If the ID card number is wrong, or the name and ID card number are wrong at the same time, the insured can go to the original city, district and county medical center to replace the new medical insurance card with the notice of receiving the errata (special for medical insurance) issued by the city, district and county medical center within 10 working days after handling the errata formalities.
Eighteen, how to apply for temporary social security card (medical insurance)
1, the following medical insurance participants can temporarily apply for a social security card (special for medical insurance) (hereinafter referred to as the medical insurance card):
(1) The social security card application procedure has been completed, but the social security card has not been issued for the time being, so it is urgent to apply for a card for medical treatment.
(2) Having received a social security card, but temporarily unable to reissue or replace the social security card due to loss or damage, and in urgent need of medical treatment.
2, for temporary medical insurance card insured, should hold the social security card (medical insurance) application form issued by the social security card issuer and my ID card, the original medical insurance card, should also carry medical insurance cards, to the neighboring county medical insurance center or city medical insurance center for temporary medical insurance card application procedures. The application form shall be kept by the city, district and county medical insurance center that temporarily handles the medical insurance card.
3, entrust others to handle, should also show the client's identity card.
4, city, district and county medical insurance center after acceptance, such as the insured received the original medical insurance card and save, the original medical insurance card to be opened; If the insured does not receive the medical insurance card or the original medical insurance card is lost, the medical insurance card shall be made in time and sent to the insured.
5. After the social security card is completed, the temporary medical insurance card will automatically become invalid.
Nineteen, how to handle sporadic medical expenses reimbursement?
1, scope of reimbursement for sporadic medical expenses
(1) city security personnel
(1) Medical expenses incurred by insured persons with medical relations in this city due to pre-hospital first aid in this city and emergency medical expenses incurred in designated hospitals in other provinces and cities. Emergency medical expenses incurred during the loss reporting period of social security card or medical insurance card;
(2) The medical expenses of the insured in other provinces and cities, the outpatient and emergency medical expenses, the observation medical expenses in the emergency observation room, and the hospitalization medical expenses.
(2) Personal insurance personnel
① Medical expenses for on-the-job personnel to observe in the emergency observation room of this city; Medical expenses for observation in emergency observation room and emergency hospitalization in designated hospitals in other provinces and cities;
(2) The medical expenses incurred in this city due to pre-hospital first aid and the emergency medical expenses incurred in other provinces and cities; Emergency medical expenses incurred during the loss reporting period of social security card or medical insurance card; Personal related medical treatment of pensioners in other provinces and cities, outpatient and emergency medical expenses incurred in local designated hospitals, medical expenses observed in emergency observation room and hospitalization medical expenses.
(3) Retired cadres
(1) medical expenses incurred by retired cadres with medical relations in this city due to pre-hospital first aid; Emergency medical expenses incurred in designated hospitals in other provinces and cities, medical expenses for observation in emergency observation room, and emergency hospitalization medical expenses;
(2) medical expenses incurred by retired cadres from other provinces and cities in their designated hospitals, medical expenses observed in emergency observation rooms, and medical expenses for hospitalization; Emergency and pre-hospital emergency medical expenses incurred during temporary return to Shanghai.
2. Units accepting sporadic reimbursement
City, county medical insurance center to accept the city insured, individual insured and retired cadres within the prescribed scope of sporadic medical expenses reimbursement. Among them, the insured who settled in other provinces and cities should first choose a county medical insurance center as the designated reimbursement unit in this city, and fill in the Registration Form for the Designated Management of Insured Persons Settled in Other Cities issued by the county medical insurance center. The reimbursement of sporadic medical expenses can only be handled in the designated reimbursement unit.
3, sporadic reimbursement, should carry the relevant documents and materials.
(1) When applying for reimbursement of outpatient and emergency medical expenses and pre-hospital emergency medical expenses, you should bring the original receipt of medical expenses, relevant medical history materials, your social security card or medical insurance card (the retired cadres produce medical certificates) and your ID card.
(2) To apply for emergency observation and reimbursement of emergency hospitalization medical expenses, you should bring the original receipt of medical expenses, discharge summary, detailed list of hospitalization medical expenses, relevant medical history data, my social security card or medical insurance card (retired cadres produce the Medical Certificate for Retired Cadres) and ID card.
(3) If you entrust others to handle the reimbursement, you should show your client's ID card.
4, the scope of the hospital
Insured persons who have medical relations with other provinces and cities, after being confirmed by the county medical insurance center, go to the local medical insurance designated hospital for medical treatment; If medical insurance is not implemented locally, you can go to hospitals above township health centers approved by local health administrative departments for medical treatment.
The above provisions shall apply to the insured person with medical relationship in this Municipality who has an emergency in other provinces and cities.
5, the scope of medical expenses
The reimbursement of sporadic medical expenses incurred by the insured in other provinces and cities according to the regulations shall be implemented according to the provisions of the basic medical insurance diagnosis and treatment project, the scope of medical service facilities and the scope of medication in this Municipality. Where there are local medical insurance regulations, reimbursement can be implemented according to local regulations, but not in accordance with the regulations of two regions at the same time.
When medical expenses are reimbursed sporadically, the deduction of personal account funds, the self-sufficiency standard for outpatient and emergency departments, the minimum payment standard and the maximum payment limit shall be implemented in accordance with the relevant annual standards of medical insurance marked on the special receipt for medical expenses when applying for sporadic reimbursement.
6. Sporadic reimbursement period
The insured shall submit an application for reimbursement of medical expenses to the medical insurance centers of neighboring cities, districts and counties within 3 months from the date when the receipt of medical expenses is issued by the medical hospital. Medical expenses exceeding 3 months will not be accepted by the municipal, district and county medical insurance centers.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.