I. Referral and transfer:
(1) Applicant: the insured residents who usually reside in the place of insurance and need to seek medical treatment outside the integrated area,
(2) Place of application: need to seek medical treatment or transfer to a designated medical institution of the second level or above in the integrated area,
(3) Processor: the designated medical institution for the registration of the referral and transfer to the hospital and uploaded (within 5 working days from the date of the issuance of the certificate of referral and transfer from the designated medical institution);
(4) Reviewer: the medical insurance online service hall. (within 5 working days from the date when the certificate of referral to hospital is issued by the designated medical institution);
(4) Auditor: the health insurance administration organization carries out the audit online on the health insurance information platform, which is valid for 3 months from the date when the referral to hospital is carried out.
(5) The period of transferring to hospital for treatment: if the transferring to hospital for treatment is more than 3 months, with the proof of the disease that the medical institution will continue the treatment, go to the health insurance agency to re-apply for the record of transferring to hospital (if the patient is hospitalized for a long period of time for treatment, every 90 days will be counted as 1 hospitalization, and if it's less than 90 days, it will be calculated according to the number of times of 1 hospitalization).
II. Emergency treatment in other places:
Short-term hospitalization across the integrated area (meaning that the insured person resides in a different place across the integrated area, visits relatives, travels, etc. for not more than 3 months), hospitalized due to an emergency, must provide a certificate of hospitalization in an emergency (diagnostic certificate of an emergency, outpatient case of emergency, or emergency admission record), and file the record with the health insurance administration agency or the health insurance information platform online within 5 working days of admission to hospital for treatment. The procedure.
Third, long-term cross-coordinated area medical treatment (hospitalization):
The cross-coordinated area of employment or residence (more than 3 months), must apply for the record of long-term personnel in a different place. The conditions and information materials required to be provided for the filing of the record of long-term personnel living in a different place,
1, living in a different place for more than 3 months (conditions)
2, the filer of the electronic voucher for medical insurance or a valid ID card or social security card;
3, to provide proof of residency (proof of residence for the person himself or the relatives to whom he has been committed to a different household registration, certificate of residence, proof of real estate, rental contract optional) One of them, and the relationship between myself and the relatives I rely on supporting materials, household registration, marriage certificate, community residence certificate, etc.). The record of long-term residents of other places is when the success of the record when it comes into effect.
Four, for the way:
1, on-site: Municipal Health Insurance Bureau service center referral room for;
2, through the (microblogging search, computer online search) Provincial Health Insurance online service hall for;
3, online for:
Online for:
Online for: Provincial Health Insurance online service hall → Health Insurance Online Service Hall → Click Enter→Register→Individual login→Enter personal web hall→I want to do→Different place filing→Different place medical filing registration (read the filing personal informational letter---I have read and agree) →Filing object (filing for oneself, filing for others) →Basic information (complete information: name, type of document, number of the document) →Different place medical filing information registration→Filing place (place of residence of the different places) →Different place filing type (different place) (long-term resident) → materials upload → complete OK.
V. Special reminders:
1. If immediate settlement is not possible due to one of the following circumstances, the insured person, after advancing the relevant medical expenses, can go to the social insurance agency for piecemeal reimbursement with his/her own social security card, records of medical records, detailed list of expenses, and settlement documents:
Participants who have gone through long-term Participants who have applied for long-term out-of-town medical procedures, the medical expenses incurred in designated medical institutions during the period of out-of-town medical procedures; the in-patient medical expenses incurred after being diagnosed by a hospital at or above the municipal level and going through the procedures of transferring to an out-of-town tertiary hospital or a hospital where the national key specialties are located due to the difficult and serious diseases that cannot be diagnosed and treated due to the limited medical technology and equipment conditions in the city.
2. If a participant is referred to a designated medical institution outside of the city for inpatient treatment in accordance with the prescribed procedures, the payment ratio will be reduced by 5 percentage points on top of the original ratio; if a participant is directly referred to a designated medical institution in the city and other counties and districts in the city for inpatient treatment without being referred to a designated medical institution according to the prescribed procedures, the payment ratio will be reduced by 15 percentage points on top of the original ratio; and if a participant is not directly referred to a designated medical institution outside of the city for inpatient treatment without being referred to a designated medical institution according to the prescribed procedures, the payment ratio will be reduced by 15 percentage points on top of the original ratio. For those who are hospitalized in designated medical institutions outside of the city without being referred as required, the payment ratio will be reduced by 20 percentage points on top of the original ratio.
In summary: "If a hospital is unable to treat a patient due to technical and equipment constraints, the patient shall be transferred to a hospital only after discussion within the department or by the head of the department, and after the medical department has reported to the president or the vice-president in charge of the business for approval, and contacting the transferring hospital in advance to obtain its consent." , "When a patient is transferred to a hospital, if it is estimated that his condition may be aggravated or he may die on the way, he should be kept in the hospital for disposal, and then transferred to another hospital when his condition has stabilized or the danger has passed. Heavier patients should be escorted by medical personnel when they are transferred to the hospital. When a patient is transferred to a hospital, a summary of the patient's medical record should be transferred with the patient. When a patient is discharged from the transferring hospital, a summary of treatment should be written, submitted to the case room, and returned to the transferring hospital. A patient transferred to a nursing home shall carry only a summary of the medical record."
Legal basis:
"Rules for the Implementation of the Regulations on the Administration of Medical Institutions"
Article 88
Special examination and special treatment refer to diagnostic and therapeutic activities with one of the following circumstances:
(1) examinations and treatments that have certain dangers and may have undesirable consequences;
(2) examinations and treatments that may cause adverse consequences to the patient due to his or her special physical condition or critical condition, may produce adverse consequences and danger to the patient's examination and treatment.