The new policy of medical treatment in different places in 2023 is as follows:
1, the scope of medical personnel in different provinces has expanded.
Before the reform, there were four types of personnel: resettling retirees in different places; Living in a different place for a long time; Resident in different places; Referral of medical staff from different places.
After the change, it is divided into two categories: the first category of inter-provincial permanent residents includes retirees resettled in different places; Living in a different place for a long time; Resident in different places; The second category of inter-provincial temporary medical personnel includes those who are referred to other places for medical treatment; Emergency rescue personnel in different places due to work, tourism and other reasons; Other inter-provincial temporary medical personnel;
2. The validity period of medical treatment in different provinces is different.
After the inter-provincial permanent residents register for the record, the record is valid for a long time, and the number of visits is not limited.
In principle, the validity period of inter-provincial temporary medical personnel is not less than 6 months. During the validity period, they can see a doctor many times in the medical place and enjoy the direct settlement service of cross-provincial medical treatment in different places, without a medical record.
3. It is more convenient to seek medical treatment across provinces.
The filing channels have been further broadened; The coverage of medical treatment in different places has been further expanded; You can seek medical treatment in different places with a code;
4, clear inter-provincial temporary medical personnel reimbursement policy.
The reimbursement standard for inter-provincial temporary outpatient medical treatment can be lower than the reimbursement level of medical institutions at the same level in the insured area. In principle, the reduction of the payment ratio of referral personnel from different places and emergency rescue personnel shall not exceed 10 percentage point, and the reduction of the payment ratio of other inter-provincial temporary outpatient medical personnel for non-emergency referral shall not exceed 20 percentage points.
5. Support long-term residents to enjoy two-way treatment across provinces.
In order to meet the actual needs of long-term residents across provinces to return to the insured place for medical reimbursement due to visiting relatives and other reasons, long-term residents across provinces are allowed to enjoy treatment at both the filing place and the insured place.
If it is really necessary to go back to the insured place for medical treatment within the validity period of inter-provincial permanent residents' filing, you can enjoy the direct settlement service of medical insurance in the insured place, which is not lower than the inter-provincial referral treatment level in principle;
6. It can be solved directly, because the emergency department has no time to file a case.
Emergency rescue expenses are included in the scope of direct settlement of inter-provincial medical treatment in different places, and emergency personnel in different places are regarded as having been filed, and there is no need to provide additional filing materials, so as to realize direct settlement of inter-provincial medical treatment in different places according to the relevant treatment standards of the insured places;
7. You can have medical records in different places.
Unable to go through the formalities for filing, the insured shall go through the formalities for filing and registration from the date of admission before the inter-provincial discharge settlement, and the designated medical institutions in different places shall provide direct settlement services as required; If the insured person is discharged from the hospital at his own expense, he can go through the registration formalities at the medical insurance agency in the insured place and apply for manual reimbursement;
8, do not belong to the third party's responsibility for trauma expenses included in the scope of medical insurance reimbursement.
Traumatic medical expenses without third-party liability that meet the requirements of medical treatment management can be included in the direct settlement scope of medical treatment in different provinces. After signing the trauma commitment letter without the third party's responsibility, the insured can directly swipe the card at the medical place to settle the expenses without applying for reimbursement at his own expense.
What items does medical insurance reimbursement include?
The classification of medical insurance reimbursement and the items included are as follows:
1, general medical insurance. It mainly includes outpatient expenses, medical expenses and inspection expenses.
2. Hospitalization insurance. Mainly the daily hospitalization expenses, hospital equipment use expenses, operation expenses, medical expenses and so on.
3. Surgery insurance. Provide all expenses incurred due to the patient's need for necessary surgery.
4. Comprehensive medical insurance. Its cost range includes all expenses such as medical treatment, hospitalization and surgery.
5. Special disease insurance. Some special diseases often bring disastrous expenses to patients, which ordinary families can't bear. Such as cancer and heart disease. The major diseases that provide protection for the insured can be single diseases, such as malignant tumors, or even some cancers in malignant tumors.
I hope the above content can help you. Please consult a professional lawyer if you have any other questions.
Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid from the basic medical insurance fund in accordance with state regulations. Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits. "Notice of the Department of Finance of Ministry of Human Resources and Social Security on Doing a Good Job in the Direct Settlement of Medical Expenses of Inpatients in Different Provinces of Basic Medical Insurance" Article 21 If the referral personnel in different places go through the referral registration formalities according to the regulations (the referral category is "normal"), the hospitalization expenses shall be reimbursed according to the prescribed standards.