Suzhou foreign medical insurance reimbursement is how to reimbursement

Objects

The implementation of the management of foreign medical settlement object, must have the following conditions:

1. Participate in the city's employee health insurance, and normal enjoyment of basic medical insurance and local supplementary medical insurance treatment (excluding the enjoyment of the military personnel with disabilities from one to six levels of health care policies, enjoy civil service medical subsidies and the implementation of the integrated management of health care costs of the retirees);

2. p> 2. Long-term residence in the city's administrative region [including five cities: (Changshu City, Zhangjiagang City, Taicang City, Kunshan City, Wujiang City); seven districts (Jingyan District, Canglang District, Pingjiang District, Wuzhong District, Xiangcheng District, Suzhou Industrial Park, Suzhou High-tech Park (Huqiu District)], but the place of participation and place of residence is not in the same social insurance co-ordination area; 3. Has been applied for out-of-home health care registration procedures.

4. Have not applied for outpatient specific program procedures.

PS: urban co-ordination range, Wuzhong District, Xiangcheng District, Industrial Park, not between each other to implement the management of medical settlement, that is: the insured person's place of insurance and place of residence are in the urban administrative area (including the seven districts) within the implementation of the object of the management of the settlement of the medical settlement is not included in a different place.

Second, the handling process

1. Eligible participants with their own medical insurance card, fill out the "application form for settlement of medical treatment in a different place", to the social security agencies in the place of participation in the application for settlement of medical treatment in a different place.

2. After completing the application and registration procedures, the insured person will settle the medical expenses incurred at the designated medical institution in his/her place of residence in cash, and then go to the social security agency in his/her place of residence for settlement and reimbursement by presenting the above application form, his/her resident identity card, the original invoices, the medical records, and a detailed list of the expenses, etc.

3.

3. The social security agency in the place of medical treatment will review the medical expenses according to the drug list and diagnosis and treatment service items of the coordinated area, determine the expenses that meet the requirements of medical insurance settlement, and through the "SuZhou cross-district medical settlement platform", calculate and determine the reimbursement amount according to the requirements of the settlement of the employees' medical insurance treatment in the place of medical treatment and pay it to the insured person directly. The amount to be reimbursed is calculated and paid directly to the insured person.

Third, notes

1. After the insured person to complete the registration procedures for settlement of medical treatment in a different place, the social security agencies in the insured place will no longer accept the settlement of medical expenses reimbursement business; of which the enterprise retirees, from the next year onwards, to stop the issuance of their medical insurance personal account amount.

2. Participants should be in the social security agencies in the place of participation in the settlement year, to the social security agencies in the place of medical treatment for the settlement of medical expenses reimbursement procedures; cross-settlement year for the settlement of medical costs as a settlement of the settlement year for the settlement of the costs incurred in the year, in accordance with the place of participation in the employee health insurance settlement provisions of the year.

3. If the insured person needs to cancel the settlement for medical treatment in a different place, or needs to change the place of medical treatment due to the relocation of his place of residence to other coordinated areas of the city, he should go to the social security agency of the place where he is insured to apply for cancellation of the application for settlement or change of the application for settlement for medical treatment in a different place. Participants cancel the settlement of foreign medical treatment, in accordance with the provisions of the medical insurance outside the residence of the implementation; back to the place of residence of the insured, but also for the cancellation of medical treatment outside the residence of the formalities.

4. For various reasons, if the participants' employee health insurance status is interrupted or the relationship is terminated, and they suspend or stop enjoying the employee health insurance benefits, the settlement of medical treatment in other places will be suspended or stopped accordingly.

5. If a participant needs to be hospitalized outside the country, he or she can directly apply for registration and filing procedures for hospitalization outside the country at the social security agency in his or her place of residence. If a participant incurs medical expenses for hospitalization or emergency medical treatment that meets the requirements, the social security agency in his/her place of residence will review and settle the payment.

6. Participants need to apply for outpatient specific items of medical treatment, with relevant diagnostic certificates and their medical cards, to the social security agencies in the place of insurance for registration and confirmation procedures, while canceling the settlement of outpatient medical care.

7. The insured person for real-time medical assistance, and has been in the insured social security agencies to complete the registration procedures for the declaration of eligibility for assistance, its real-time medical assistance treatment can be realized with the medical insurance treatment of settlement in different places.

Who needs to be filed for medical treatment in a different place

1, retired people resettled in a different place after retirement and the household registration moved to the place of settlement.

2. Long-term residents in a different place: those who live in a different place and meet the requirements of the place of insurance.

3. Resident workers in a different place: those who are sent by their employers to work in a different place and meet the requirements of the insured place.

The above three categories of personnel referred to as "living outside the personnel", the procedures will be suspended at the same time as the Suzhou social security citizen card in the insured place of credit card settlement function, for the record 60 days before applying for the record to cancel the procedures.

4, foreign referrals: refers to those who suffer from difficult and serious diseases that cannot be diagnosed and treated by the medical technology and equipment conditions limited to the city, and need to be referred to foreign hospitals for treatment by the city and county hospitals with referral qualifications. The referrals need to go to the medical institutions with referral qualifications in the city for the referral procedures, and the record is valid for one year.

Suzhou medical reimbursement guide

I. Scope of application

The following expenses are to be paid by the insured person in advance, and then to the social security agency for review and settlement according to the regulations:

1. The insured person who has completed the filing procedures for medical treatment in a different place, and according to the type of medical treatment in a different place, incurs in the place of medical treatment, and complies with the provisions of the settlement of medical insurance, but is unable to settle the medical expenses directly. Medical expenses incurred in accordance with the provisions of the medical insurance settlement regulations when they go directly to a place other than the place of insurance for medical treatment without going through the required procedures of filing a referral for medical treatment in a different place;

3. Medical expenses incurred due to a sudden emergency, critical or serious illness without using a social security card;

4. Medical expenses incurred in accordance with the provisions of the anti-rejection medication for the treatment of an organ after transplantation after the registration and confirmation procedures for the specific items of the outpatient clinic have already been completed;

5. Medical expenses incurred by insured students in their place of domicile or current place of study;

6. Medical expenses incurred from September to December of the year of enrollment for college freshmen who are enrolled in the city's residents' medical insurance for the first time;

7. Medical expenses incurred from the date of birth of newborn babies who have gone through the procedure of enrolling in the residents' medical insurance within three months of their birth until the end of the month of the enrollment and payment procedures;

8. Medical expenses incurred by levied children who are entitled to the residents' medical insurance benefits as required;

9. Medical expenses incurred from the date of enrollment and payment procedures;

10. Enjoy the residents of the medical insurance benefits of the expropriated farmers, land expropriation compensation and resettlement program approved by the date of land expropriation to the end of the end of the month of the cost of land expropriation to allocate health insurance premiums incurred during the period;

9. In line with the provisions of the city's residents of the medical insurance, need to be reimbursed for the settlement of other costs.

Second, the submission of materials

1. social security card;

2. my bank card account number (limited to Industrial and Commercial Bank of China, Bank of China, Bank of Communications, Construction Bank, Agricultural Bank of China, Postal Savings Bank, Bank of Jiangsu and Bank of Suzhou);

3. medical bills and detailed lists of medical expenses, outpatient medical records, inpatient hospital discharge records;

4. due to a sudden acute and critical care, should bring an emergency diagnosis (emergency diagnostic certificate). Emergency diagnosis should be carried (outpatient emergency medical records); trauma, trauma-related materials should be carried;

5. entrusted to another person to handle, the agent also need to provide the original resident identity card.

Third, the procedure

1. The insured person with the above materials to the social security agency for review and payment procedures.

2. The social security agency pre-approval, print the "Suzhou City, the basic social health insurance medical expenses of sporadic reimbursement acceptance form", to the insured person to sign to confirm.

3. Social security agencies within 30 days of the date of acceptance, review and determine the amount that can be paid by the medical insurance fund, and through the "online payment" method, the reimbursement of the amount of payment to the designated bank card account I filled out.

Fourth, notes

1. Participants in the social security agency for sporadic reimbursement of medical expenses, according to the occurrence of each expense (hospitalization medical expenses according to the date of discharge) applicable to the type of medical insurance treatment, the type of treatment in the reimbursement of the settlement of formalities in the settlement of the payment standard, the amount of reimbursement of the settlement of the payment is calculated; reimbursement of the settlement of medical expenses across the year, the cost of reimbursement settlement procedures are counted in the year. The amount of the reimbursement will be calculated.

2. All medical expenses incurred by a participant that require piecemeal reimbursement should be reviewed and reimbursed within the current billing year (from April to March for non-employed residents, and from January to December for students and children); this can be extended for up to 12 months under special circumstances.

3. The medical expenses of participants living abroad for medical treatment in other places are reimbursed sporadically

4. Participants who do not apply for referral for medical treatment in other places according to the regulations for the record, and go directly to a place other than the place of participation in the foreign medical treatment, incurred in accordance with the provisions of the medical insurance settlement provisions of medical expenses, according to the provisions of the residents of the basic medical insurance fund in proportion to the portion of the settlement, according to the original provisions of the settlement ratio of 80% settlement reimbursement.

5. For the first time to participate in the urban residents of the medical insurance of freshmen, enrolled in the year of September to December medical expenses incurred in accordance with the provisions of the medical insurance settlement must be January 1 to June 30 of the following year for reimbursement and payment procedures.

6. For newborns who are enrolled in resident health insurance within three months of their birth, and whose first enrollment time and date of birth crosses over the billing year, they should enroll in the enrollment procedures and pay the resident health insurance premiums for the year of their birth at the same time, in order to be reimbursed and settled the medical expenses incurred after their birth and up to the end of that year.

7. Participants need to settle the details of the bill, you can within six months with the "acceptance of the bill" and I (or on behalf of the resident ID card), to the social security agency to receive; can also be logged on the website of the Suzhou Social Security Center in one year, in the "sporadic reimbursement bill printing" section with the "acceptance of the bill" number of self-service query, print.

8. The insured college students can be reimbursed directly by the designated medical institutions in the school for the general outpatient medical expenses incurred without the use of the social security card and cash settlement due to emergency or returning to the place of domicile for medical treatment; if there is no designated medical institution in the school, the designated department of the school will arrange for a special person to collect and summarize the social security card, the medical bills and detailed lists of medical expenses, the outpatient medical records, the discharge records, and the bank account number, then go to the social security agency for examination and settlement. After collecting and summarizing social security cards, medical bills and detailed lists, outpatient medical records, discharge records and bank card account numbers, the school will go to the social security agency to go through the procedures of examination and settlement. Among them, the insured college students who have been registered for outpatient medical treatment, outpatient specific programs or real-time medical assistance, their outpatient medical expenses must be paid by the school or by themselves to the social security agency for review and settlement procedures.