There should be provisions for reimbursement of medical insurance in different places in various places, and all those within the scope of medical insurance can be reimbursed, but the proportion may be reduced. Now I will give you a policy guide for medical treatment in different places of Qingdao's basic medical insurance for your reference. 1. What kinds of basic medical insurance are there in Qingdao? The basic medical insurance for medical treatment in different places refers to the medical behavior that the insured is filed or approved by the medical insurance agency outside the medical insurance co-ordination area of our city. There are five main types: 1. Referral from different places; 2. Emergency treatment in different places; 3. Resettlement in different places; 4. Long-term overseas presence; 5. Students go back to their hometown for treatment. Second, what are the conditions for handling off-site referral? How to deal with it? (1) If the insured person needs to go through the referral procedures for hospitalization in different places due to illness, he shall meet the following conditions at the same time: 1. The disease he suffered was an incurable disease that could not be diagnosed by expert consultation organized by the third-class first-class hospital or municipal specialized hospital in this city, or could not be further treated due to the limitations of medical technology and equipment in this city. 2. The hospitals transferred from different places are designated hospitals for local basic medical insurance, and the level of diagnosis and treatment is higher than that of our city. (2) If the insured person meets the conditions for referral from other places due to illness, the procedures for referral from other places shall be handled according to the following procedures: 1. I or my relatives apply to the third-class first-class hospital or municipal specialized hospital in this city. The attending physician and above fill in the Approval Form for Referral Qualification of Qingdao Basic Medical Insurance in Different Places. The hospital organizes expert consultation and puts forward opinions. The hospital medical insurance office reviews and registers, and the dean in charge reviews and signs. 2. The agent carries the "Approval Form for Remote Referral Qualification" and the consultation opinions of medical experts, and goes through the examination and approval procedures at the municipal medical insurance center. If it is found that it meets the conditions for referral in different places, it will be approved on the spot. 3. Is the reimbursement rate of hospitalization expenses for referral from different places the same as that for hospitalization in Qingdao? It's different. The reimbursement rate of hospitalization expenses incurred by the insured in different places is 5 percentage points lower than that of hospitalization in the same level hospital in Qingdao. For example, the on-the-job employees who participate in the basic medical insurance for urban employees are hospitalized in the third-level designated hospitals in our city, and the first reimbursement rate of their medical expenses below 5,000 yuan is 84%, and the first reimbursement rate of hospitalization medical expenses incurred in hospitals at the same level in different places is 79%, and so on. 4. What is the time limit for examination and approval of off-site referral? Can I apply for a second hospitalization in a different place within the effective time? It is valid for 6 months from the date of examination and approval of referral from different places, and only one hospital can be selected for each hospitalization. For more than 6 months or the second time, it is necessary to go through the referral procedures again. Patients with malignant tumor who need to continue radiotherapy and chemotherapy after operation shall be regarded as referral within the validity period. 5. Can medical expenses in different places without referral be reimbursed? The medical expenses of the insured person who has not been referred to another place cannot be reimbursed in principle. However, those who meet the conditions of off-site referral and fail to go through the procedures for off-site referral for special reasons may, within two months after discharge, bring medical records and other related materials, explain in detail in writing the reasons for not making referral, and submit an application for reimbursement to the municipal medical insurance center. The municipal medical insurance center conducts regular monthly examination and approval. If approved, its medical expenses will be included in the scope of medical insurance reimbursement, but the reimbursement ratio is lower than that of hospitalization in the same hospital in our city 10 percentage point. If the insured person's referral in different places is not approved, or the referral in different places is not handled, and the application for reimbursement is not filed within two months after discharge, the medical expenses incurred shall not be paid by the medical insurance fund. 6. What are the conditions and regulations for emergency reimbursement in different places? (1) If the insured person is hospitalized in a different hospital due to an emergency during business trip, visiting relatives or going out, the following conditions are met, and his medical expenses can be included in the scope of medical insurance reimbursement after being confirmed by the municipal medical insurance center. Do not meet the conditions, the medical expenses incurred, the medical insurance fund will not pay. 1. Hospitalization conforms to the emergency scope, standards and conditions stipulated by the health administrative department; Or the continuous observation time of emergency observation exceeds 24 hours (except for emergency rescue of dead people). 2. Treatment hospitals are designated medical institutions for local basic medical insurance in principle. (two) emergency hospitalization in different places only reimbursed medical expenses incurred in one hospital. When the medical expenses incurred in two hospitals are reimbursed, materials such as referral procedures for transferring from lower hospitals to higher hospitals due to illness should be provided. If the materials are incomplete, the medical insurance fund will not pay. 7. What are the conditions for resettlement and long-term overseas assignment? How to go through the filing procedures? (1) Conditions: Retirees, elderly residents or on-the-job personnel living abroad for work (hereinafter referred to as off-site personnel) must live in a relatively fixed area, and in principle have lived stably for more than 1 year. (2) Those who meet the above conditions can bring the following materials to their municipal and district medical insurance agencies: 1. Fill in the Medical Record Form of Basic Medical Insurance for Urban Workers in Qingdao. 2. In case of resettlement in different places, provide relevant materials such as the registration certificate or long-term residence certificate issued by the local police station; If you go abroad for a long time, provide the labor contract and its copy, the documents sent by the unit and the copy of the license of the peripheral organization and other proof materials for going abroad. 3. Those that meet the requirements shall be put on record. 8. What are the rules for relocation and long-term assignment? 1. When handling medical records in different places, medical patients in different places should choose one of the first, second and third-level hospitals designated by the local basic medical insurance as their designated hospitals. 2. People from different places suffering from chronic serious illness can apply for outpatient serious illness certificate in the medical insurance agency, but the designated hospitals selected for outpatient serious illness treatment should be consistent with the designated hospitals selected for medical records in different places. 3. If the resident or working place of personnel in different places changes or changes the designated hospitals, they should go through the formalities for medical treatment in different places again. Back to the city to live or treat in this city, should hold the original "off-site medical record form", in a timely manner to the medical insurance agencies for off-site medical record cancellation procedures. If the cancellation procedures are not handled in time, the medical expenses treated in the designated hospitals in this city will not be reimbursed by the medical insurance fund. 4. If people from different places need to be transferred to a hospital outside their place of residence for treatment due to changes in their illness, they should go through the referral procedures at the highest level hospital designated by themselves. When reimbursing medical expenses, the certificate of referral procedures issued by the designated hospital in the place of residence shall be provided. 5. The medical expenses incurred in different places before filing or filing shall not be reimbursed by the medical insurance fund. 9. Can students studying in Qingdao go back to their hometown for hospitalization? How to apply for reimbursement? Of course. If a student is hospitalized in his hometown due to illness during the winter and summer vacation or during the suspension of study, after the treatment, he shall go to the medical insurance agency where the school is located to handle the medical expenses reimbursement procedures with the valid certificate issued by the school explaining the student's school status, hometown and the basic situation of treatment in his hometown due to illness and the relevant materials of hospitalization. X. How to handle the reimbursement procedures for medical expenses in different places? Medical expenses incurred in different places shall be paid in advance by myself. After the treatment, the unit or myself (or my family members) shall apply for reimbursement according to the following procedures: (1) Submit an application for reimbursement to the affiliated medical insurance agency with the medical records of emergency and hospitalization (including doctor's orders, relevant inspection reports, surgery and anesthesia records, etc.). ), discharge records, valid bills, detailed list of expenses, and discharge records. Among them, the remote referral, need to provide the "remote referral approval form" approved by the municipal medical insurance center. (two) the materials are complete and meet the requirements, and the procedures for accepting reimbursement are handled; If the materials are incomplete, the applicant shall prepare the relevant materials within 15 working days. (3) The medical insurance expense auditor shall audit the medical expenses in different places according to the provisions of the scope of use of basic medical insurance drugs, the scope of diagnosis and treatment items and the scope of medical service facilities in Qingdao. (four) the applicant according to the "business acceptance receipt" agreed time, with ID cards and other valid documents, to the medical insurance agencies to receive reimbursement of medical expenses. Among them, the outpatient expenses for serious illness are reimbursed once a medical year in principle, and the medical expenses exceeding 3,000 yuan can be reimbursed by half. 1 1. Can hospitalization expenses for accidental injuries in other places be reimbursed? Of course. If the insured is hospitalized in other places due to accidental injury, he shall provide the description of accidental injury, witness certificate and other relevant materials. If the insured person meets the scope of medical insurance reimbursement after approval by the municipal medical insurance center, he may apply for medical insurance reimbursement according to the emergency department in different places.
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