First, choose to file a case first or refer it first:
1, generally put on record first, and then refer to it.
2. Generally, if there is no referral for the record, you cannot enter the remote transfer platform or settle accounts.
3. If it has been filed, you can use the previous medical insurance quota. If you go to a hospital in a big city without filing for yourself, then the previous quota will be useless. So if this has been filed, you can apply according to the normal medical insurance procedures.
Two, the two are different in filing procedures:
1, long-term off-site medical record process:
(1) for the record, first in the insurance institution for the record.
(2) Select the designated medical institutions across cities or provinces for medical treatment.
(3) If you hold a card for medical treatment, you must carry a national unified social security card for medical treatment.
Three, remote referral medical records process:
1. I was treated in Maoming.
2, the city's designated medical institutions to diagnose and issue a referral form.
3, filing, insurance institutions for the record.
4. Take the card to the referral hospital for medical treatment.
Note: Social security card is the only voucher for direct settlement of medical treatment in different places. The insured person must show his social security card when seeking medical treatment and settlement.
Fourth, medical care:
1. Due to the limitation of local medical level, some critically ill patients and patients whose long-term treatment effect was not obvious in local designated medical institutions were transferred to other places for medical treatment.
2. Some people participate in endowment insurance and medical insurance as freelancers in the local area, but they usually work in other places, and when they are sick, they seek medical treatment at their workplace.
3. After retirement, some employees miss their homeland and go back to their hometown to provide for the aged, and seek medical treatment in the local hospital in their hometown.
4. Some enterprises have contracted projects abroad or set up marketing agencies in other places, and their employees have been working and seeking medical treatment in other places for a long time.
Verb (abbreviation of verb) Applicant:
1, retired insured persons resettled in different places;
2. The insured who has lived in the same place in China for more than half a year after retirement;
3. Insured who work in different places in China.
Six, the insured to other places (excluding Hong Kong, Macao and Taiwan) during the business trip, study, visit relatives suffering from acute diseases, can go to the local public hospital for medical treatment, outpatient medical expenses shall be borne by the insured; The expenses incurred by the approved hospitalization (including emergency observation and treatment) shall be paid by the insured in cash, and the unit manager shall apply for sporadic reimbursement to the municipal medical insurance center with the following information:
1, certificate of the insured unit;
2 copies of the front and back of the medical insurance card;
3. Discharge or diagnosis certificate;
4. Detailed list of medical expenses;
5. Invoice for medical expenses (the name of the reimburser is indicated on the back);
6. Copies of hospital medical records.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 25 The state establishes and improves the basic medical insurance system for urban residents.
The basic medical insurance for urban residents combines individual contributions with government subsidies.
People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Notice of the State Medical Insurance Bureau and the Ministry of Finance on Further Improving the Direct Settlement of Medical Treatment in Different Provinces of Basic Medical Insurance
Six, strengthen the supervision of direct settlement funds for medical treatment across provinces.
We will improve the supervision mechanism of the inter-provincial direct settlement fund for medical treatment in different places, improve the system of regional cooperation and joint inspection, strengthen guidance on key areas and key areas for direct settlement of medical treatment in different places across provinces, and strengthen supervision and assessment. To implement the supervision responsibility of the medical treatment place and the insured place, the medical insurance department of the medical treatment place should take the direct settlement of medical treatment across provinces and different places as the key content of daily supervision, special inspection and flight inspection, combine the local reality and the characteristics of direct settlement of medical treatment across provinces and different places, crack down on all kinds of fraud and insurance fraud, and cooperate with the insured place to do relevant verification work. The medical insurance department of the insured place should regularly analyze the use of medical insurance funds in different provinces, accurately lock the clues of suspicious problems, and actively carry out problem verification to ensure the safe and rational use of medical insurance funds. The medical insurance fund and deduction recovered by inter-provincial medical supervision in different places shall be returned to the account of the insured place according to the original channel, and the administrative punishment and agreed liquidated damages shall be handled by the medical insurance department of the medical place according to the regulations.
Two, improve the policy of direct settlement of medical treatment across provinces.
(a) unified hospitalization, general outpatient and outpatient chronic diseases and special diseases across the province direct settlement fund payment policy. Inter-provincial direct settlement of hospitalization, general outpatient service and outpatient service for chronic diseases and special diseases shall, in principle, be implemented according to the payment scope and relevant regulations (such as basic medical insurance drugs, medical service items, medical consumables, etc.) stipulated by the insured place, and the relevant policies such as the minimum payment standard, payment ratio, maximum payment limit and outpatient disease range of the basic medical insurance fund shall be implemented.
(2) Defining the scope of medical records in different places. Insured persons who live in different provinces for a long time or temporarily go out for medical treatment can enjoy the direct settlement service for medical treatment in different places after filing medical treatment in different places. Among them, inter-provincial permanent residents include retirees resettled in different places, permanent residents in different places, permanent residents in different places and other personnel who have worked, lived and lived outside the insured provinces, autonomous regions and municipalities directly under the Central Government (hereinafter referred to as provinces) for a long time; Inter-provincial temporary medical personnel include those who have been referred for medical treatment in different places, emergency personnel in different places due to work, tourism and other reasons, and other inter-provincial temporary medical personnel.
(three) standardize the validity of medical records in different places. Those who live in different provinces for a long time shall register for the record, and the record shall be valid for a long time; The insured place can be set to change or cancel the filing period, in principle, not more than 6 months. In principle, the validity period of inter-provincial temporary medical personnel is not less than 6 months. During the validity period, you can see a doctor many times in a medical place and enjoy the direct settlement service for medical treatment in different provinces.
(4) Allow trauma insured persons who have to reissue medical records in different places and have no third-party responsibility to enjoy direct settlement services for medical treatment across provinces. If the insured goes through the medical record in different places before the inter-provincial discharge settlement, the designated medical institution connected with the medical place shall handle the inter-provincial direct settlement of medical expenses for the insured. Insured persons who go abroad for medical treatment at their own expense may apply for manual reimbursement of medical insurance according to the provisions of the insured place after discharge. At the same time, trauma expenses without third-party liability that meet the requirements of medical place management can be included in the scope of direct settlement of medical treatment in different provinces, and medical place agencies should include related expenses in the scope of verification.
(five) residents who support long-term inter-provincial can enjoy medical insurance benefits at the same time at the place of filing and insurance. When inter-provincial permanent residents seek medical treatment and settlement at the filing place, the Qifubiaozhun, payment ratio and maximum payment limit of the basic medical insurance fund shall, in principle, implement the local medical treatment standards stipulated by the insured place; If it is really necessary to go back to the insured place for medical treatment within the validity period of the record, you can enjoy the medical insurance settlement service in the insured place, which is not lower than the inter-provincial referral treatment level of the insured place in principle. Among them, if the insured person goes through the filing procedures for inter-provincial permanent residents in the form of personal commitment, after completing the relevant filing materials, he should fulfill his promise and enjoy medical insurance benefits at the filing place and the insured place. Inter-provincial permanent residents who meet the conditions for going abroad for medical treatment shall implement the inter-provincial referral and transfer treatment policy in the insured areas.
(6) Reasonably determine the inter-provincial reimbursement policy for temporary medical personnel. According to the level of economic and social development, people's health needs, the support capacity of medical insurance fund and the requirements of graded diagnosis and treatment, all overall planning areas should reasonably set up a policy of direct settlement and reimbursement for temporary medical personnel going out across provinces. Provincial temporary medical personnel can be lower than the reimbursement level of medical institutions at the same level in the insured area. In principle, the proportion of payment for off-site referral personnel and off-site emergency rescue personnel shall not decrease by more than 10 percentage point, and the proportion of payment for other non-emergency referral inter-provincial temporary medical personnel shall not decrease by more than 20 percentage points. Strengthen the coordination between the settlement policy of medical treatment in different places and the grading diagnosis and treatment system, reasonably determine the differences in reimbursement levels of medical personnel in different levels of medical institutions, and guide the insured to seek medical treatment in an orderly manner.