Medical treatment in different places refers to the behavior of the insured person seeking medical treatment outside the insured place. Medical insurance is insurance to compensate medical expenses caused by diseases.
Insured persons who meet one of the following conditions may apply for medical treatment in different places:
1. Insured retirees who leave the insured place and live in different places for a long time across the overall planning area and obtain household registration according to the household registration management regulations;
2. The insured who has worked and lived in a different place for more than 3 months (including 3 months) for a long time;
3. The insured who has been on business trip, studying, visiting relatives and taking vacations for less than 3 months and needs treatment for sudden illness;
4. Insured persons who need to be hospitalized outside the overall planning area due to the limitation of medical technical conditions in the overall planning area.
Insured persons who meet one of the following conditions may apply for referral:
1, critically ill patients, transferred to hospital for rescue;
2. After many examinations and consultations, the diagnosis is still unclear;
3, specialist diseases, the city's designated medical institutions unconditional treatment;
4, due to illness need to do some inspection and treatment, the city's designated medical institutions do not have this equipment or do not carry out this business.
The situation of not transferring to other places for medical treatment is as follows:
1, patients who can be treated in designated medical institutions at the same level after diagnosis or whose treatment effect is not clear after transfer;
2. Patients who have been diagnosed and treated in designated medical institutions outside the district and need to continue regular diagnosis and treatment and can be diagnosed and treated in designated medical institutions at the same level;
3, critically ill patients are generally not allowed to refer, should be in the nearest designated medical institutions for rescue and treatment; When the patient still needs to be transferred after the condition is stable, it shall be handled in accordance with relevant regulations;
4, without the consent of the designated medical institutions or specialized hospitals as stipulated in the overall planning area, shall not be transferred to outside the overall planning area for medical treatment.
"People's Republic of China (PRC) social insurance law" thirtieth the following medical expenses are not included in the scope of payment of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.