Thirteen, the "medical insurance card" application procedures
City insured
City, district and county health insurance centers belonging to the insured unit, notify the unit to collect its employees' "medical insurance card. When the insured unit receives the card, it should bring the "Notice of Receiving Social Security Card (for medical insurance)" issued by the municipal or county medical insurance center, a letter of introduction from the unit, and the ID card of the recipient to the municipal or county medical insurance center to which it belongs to receive the medical insurance card, which will then be issued to the insured person.
Individually insured persons
Active employees who are individually insured shall, for the first time after enrollment in the insurance for outpatient major diseases, hospitalization, family hospital beds, or hospital observation in the emergency observation room, bring along with them the registration form for outpatient major diseases (or the hospitalization notice, or the notice of establishment of a bed in a family hospital bed) and their own ID cards to apply for a Medical Insurance Card at a neighboring district or county medical insurance center; and the individually insured persons who receive a pension shall bring along with them their own ID cards to the municipal, district or county medical insurance center. ID card, to the city and county health insurance center to apply for the "medical insurance card", and at the same time selected outpatient emergency hospitals.
Fourteenth, how to use the social security card (medical insurance)
1, "social security card (medical insurance)" (hereinafter referred to as the medical insurance card) is only for the use of the insured person, and may not be lent, fraudulent, altered or forged.
2. The card should be kept in a safe place and should not be bent, folded or scratched, and should not come into contact with magnetic objects (e.g., televisions, stereos, magnetic clasps, etc.).
3. Participants must use the Medical Insurance Card when they go to the designated hospitals in the city, dispense medicines at the designated pharmacies (excluding individual employees), or go to the municipal or county medical insurance centers for reimbursement of medical fees and other medical insurance affairs (participants who have been issued with the Social Security Card should use the Social Security Card).
4. If the Medical Insurance Card is not visibly damaged but cannot be used, the insured person can go to the neighboring municipal, district or county medical insurance centers to repair it, or replace it if it cannot be repaired.
5. If the Medical Insurance Card cannot be used due to equipment failure of the designated hospital or designated pharmacy, the medical fee will be paid by the individual in cash first, and then re-settled according to the regulations at the original hospital or pharmacy where the equipment failure occurred after the failure is eliminated.
6, working participants in the settlement abroad (out of the country) and cancellation of the city's domicile, health insurance relations transferred out of the city, the death of the participants, "medical insurance card" should be returned to the city, district and county health insurance center cancellation.
Fifteen, how to handle the loss of social security card (medical insurance)
1, lost by phone
(1) Participants who have lost their social security card (medical insurance) (hereinafter referred to as the "medical insurance card") can first call the city medical insurance center to report the loss of the phone (62533197) to report the loss of the card. When reporting the loss, you should provide the name of the person who lost it, his/her ID number, the card number of the Medical Insurance Card and the name of the organization.
(2) After the telephone report of loss is immediately confirmed by the staff of the telephone number for reporting loss, the settlement of the reported lost card will be stopped within one hour. At the same time, the person who lost the card should report the loss in writing within 48 hours (i.e., within 2 days, postponed on holidays) to the neighboring municipal, district and county health insurance centers.
(3) If the loss is reported by telephone and cannot be confirmed due to incomplete or incorrect information provided by the person who reported the loss, the person who lost the card should make a written report in a timely manner.
2, written report of loss
(1) the insured person lost the "medical insurance card", you can bring your ID card, in a timely manner to the neighboring municipal, district and county medical insurance centers for the written report of loss, and at the same time for the application for replacement of the card. If you entrust someone else to do it, you should also present the ID card of the entrusted person.
(2) written report of loss by the staff immediately after confirmation, within one hour to stop reporting the loss of the card settlement (telephone report of loss has been stopped).
3. Revocation of loss report
(1) If the insured person finds his/her medical insurance card during the period between the report of loss by phone and the written report, he/she can bring his/her medical insurance card and ID card to the neighboring municipal, district and county medical insurance centers for revocation of the loss report. If you entrust someone else to do the procedure, you should also present the ID card of the entrusted person.
(2) After the revocation of the report of loss is immediately confirmed by the staff, the settlement function of the Medical Insurance Card will be restored within one hour.
4. Others
(1) Before the city or county medical insurance center accepts the report of loss and stops the settlement of the lost card, the economic loss caused by the loss of the Medical Insurance Card shall be borne by the individual.
(2) Emergency medical expenses incurred during the period of reporting the loss of the Medical Insurance Card (from the time of reporting the loss by telephone or in writing to the time of reissuing the card) can be reimbursed piecemeal at the municipal or county medical insurance centers that accept applications for the replacement of the card at the same time that the replacement card is issued.
Sixteen, how to handle the social security card (medical insurance) card replacement (replacement), card repair
1, card replacement
(1) the insured person in the city, district and county health insurance center for the social security card (medical insurance) (hereinafter referred to as the "medical insurance card") for the loss of a written report, at the same time, you can apply for the replacement of the card application for the "medical insurance card".
(2) After the third working day from the date of application for replacement of the card, the new Medical Insurance Card can be obtained at the municipal, district and county medical insurance centers where the application for replacement of the card is processed.
(3) When receiving the new Medical Insurance Card, you should pay the required labor cost of 10 yuan.
2. Replacement of the card
(1) If the medical insurance card is damaged, you can bring your ID card and the damaged medical insurance card to the medical insurance center of the neighboring city or county to apply for the replacement of the card.
(2) After the card replacement procedure, the receiving city, district and county health insurance centers will promptly issue a new Medical Insurance Card and take back the damaged Medical Insurance Card.
(3) When receiving the new Medical Insurance Card, the required labor cost of ten yuan shall be paid.
3. Repairing the card
(1) If the Medical Insurance Card cannot be used in the hospital or pharmacy, the hospital or pharmacy shall issue a "Notice of Damage to Medical Card". The insured person should bring his/her medical insurance card and the "Notice of Damage to Medical Card", as well as his/her ID card, to the nearest municipal or county medical insurance center for card inspection within 3 days.
(2) If the damage can be repaired after the card inspection, the city, district or county health insurance center that accepts the case will repair the damage and return the original Medical Insurance Card to the insured person for further use.
(3) If the card is not repairable after inspection, the accepted municipal, district and county health insurance centers will replace the card with a new one and take back the original card. If it belongs to the participant's improper storage, the cost of labor shall be paid in accordance with the regulations of ten yuan.
4. Others
(1) If you entrust someone else to handle the above matters, the entrusted person shall present his/her ID card.
(2) For emergency and outpatient medical expenses incurred on the same day when the Medical Insurance Card is damaged and cannot be used, you can apply for piecemeal reimbursement to the municipal or county medical insurance centers within one month after completing the procedures of repairing or reissuing the Medical Insurance Card, carrying the Medical Insurance Card and the "Notice of Damage to the Medical Insurance Card," the identity card of the person and the receipts of the medical expenses.
Seventeen, how to handle the social security card (medical insurance) errata
1, application for errata
"Social security card (medical insurance)" (hereinafter referred to as the "medical insurance card") of the name and identity card number of the error, the insured person can bring their own identity card, "medical insurance card", to the neighboring city, district and county medical insurance center to apply for errata. If the application is entrusted to another person, the identity card of the entrusted person should also be presented.
2, errata
City, district and county health insurance center acceptance, according to the content of the application for errata as follows:
(1) belonging to the "medical insurance card" on the name or identity card number printing errors, the replacement of the new "medical insurance card", while the original "medical insurance card" to be withdrawn.
(2) If the words in the name belong to remote characters, the staff will fill in the correct name manually, stamp the remote character confirmation seal and issue it back to the insured.
(3) If the original information in the computer system is incorrect, the following treatment will be made according to the situation:
1) If the name belongs to the insured person of the city's old-age insurance, the "Notification Sheet of Errors in the Procedures of Handling Name and ID Card Number" will be issued. By the insured person's unit of the operator to the relevant county social security center (individual insured person by the person directly to the county social security center), the county social security center by the verification, issued by the return receipt. The participants themselves or their units in the receipt of the receipt of the next month after 15 days, with the receipt to the original handling of the city, district and county health insurance center to replace the new "medical insurance card";
② does not belong to the city's old-age insurance participants, the name of the wrong by the city, district and county health insurance centers to directly carry out the investigation of the error, the replacement of the new "medical insurance card"; ID card number wrong, or name and ID card number wrong at the same time, the participants If the ID card number is wrong, or the name and ID card number are wrong at the same time, the insured person can bring the "Errata Social Security Card (for medical insurance) Receipt Notice" issued by the municipal, district and county medical insurance centers to the original municipal, district and county medical insurance centers to replace the new "medical insurance card" after 10 working days from the errata procedure.
Eighteen, how to apply for a temporary social security card (for medical insurance)
1, the following health insurance participants can temporarily apply for a social security card (for medical insurance) (hereinafter referred to as the medical insurance card):
(1) has been applied for a social security card for the application procedures, but the social security card has not yet been issued to the temporary, in urgent need of medical care with the card.
(2) Those who have been issued a social security card, but have not been able to replace or replace the card due to loss or damage, and are in urgent need of medical treatment.
2. Participants who are temporarily applying for a medical insurance card should apply for a temporary medical insurance card at a neighboring district or county medical insurance center or a municipal medical insurance center by presenting an application form for a social security card (for medical insurance) issued by the social security card issuing agency, as well as their own ID cards, and if they originally received a medical insurance card, they should bring their medical insurance cards as well. The application form will be retained by the city or county health insurance center where the temporary health insurance card is applied for.
3. If you entrust someone else to handle the application, you should also show the ID card of the entrusted person.
4, the city, district and county health insurance centers to accept, such as the participant originally received a health insurance card and save, the original health insurance card to be opened; such as the participant did not receive a health insurance card or the original health insurance card is lost, should be made in a timely manner and issued to the participant health insurance card.
5. The temporary medical insurance card shall automatically become invalid after the social security card is completed.
Nineteen, how to handle the medical expenses reimbursement
1, the scope of medical expenses reimbursement
(1) City insured
1) the medical expenses incurred by the insured whose medical relationship is in the city due to the pre-hospital emergency in the city, and the emergency medical expenses incurred in the designated hospitals in foreign provinces and cities. Social Security Card" or "medical insurance card" reported loss or report the loss of emergency medical expenses;
② medical relations in foreign provinces and cities of the insured, in the local designated hospital outpatient emergency medical expenses, emergency observation room hospitalization observation medical expenses, hospitalization medical expenses.
(2) individual insured
1) the medical expenses incurred in the city of the emergency observation room hospitalization observation; in the provinces and cities designated hospitals in the emergency observation room hospitalization observation, emergency hospitalization medical expenses;
2) medical relations in the city of the individual pensioners, in the city of the medical expenses incurred in the city of the pre-hospital emergency medical expenses in the provinces and cities emergency medical expenses; Social Security Card" or "medical insurance card" or "reported loss or loss of emergency medical expenses; medical relations in foreign provinces and cities to receive pensioners, in the local designated hospital outpatient emergency medical expenses, emergency observation room stay for observation, inpatient medical expenses.
(3) retired cadres
① retired cadres in the city medical relations, medical expenses incurred due to pre-hospital emergency; in the designated hospitals in foreign provinces and cities in the emergency medical expenses, emergency observation room hospitalization observation medical expenses, emergency hospitalization medical expenses;
② medical relations in foreign provinces and cities of retired cadres in the hospitals of their designated outpatient emergency medical expenses, emergency observation room hospitalization observation medical expenses, hospitalization medical expenses. hospitalized medical expenses, hospitalization medical expenses; temporary return to Shanghai emergency, pre-hospital emergency medical expenses.
2. Units accepting sporadic reimbursement
City and county health insurance centers accept sporadic reimbursement of medical expenses within the scope of the provisions of the city insurance, individual insurance and retired cadres. Among them, the settlement of foreign provinces and cities of the insured, should first select the city of a district and county health insurance center as a fixed reimbursement unit, and fill in the district and county health insurance centers issued by the "settlement of foreign cities in the city of the insured fixed management registration form", the medical expenses of sporadic reimbursement is limited to the fixed reimbursement unit for processing.
3, sporadic reimbursement, should bring the relevant documents and information
(1) apply for reimbursement of outpatient emergency, pre-hospital emergency medical expenses, should bring the original receipt of medical expenses, relevant medical history, my "social security card" or "medical insurance card" (retired cadres show "retired cadres medical card"), my ID card.
(2) When applying for reimbursement of medical expenses for hospitalization in the emergency observation room or emergency hospitalization, the applicant shall bring along the original receipts of medical expenses, discharge summary, detailed list of hospitalization medical expenses, relevant medical history, his/her Social Security Card or Medical Insurance Card (retired cadres shall present their Retired Cadre Medical Card), and his/her identity card.
(3) If you entrust another person to handle the reimbursement, you should present the ID card of the entrusted person.
4, the scope of the hospital
The medical relationship in foreign provinces and cities of the insured, confirmed by the county medical insurance center, should be to the local health insurance designated hospitals; local health insurance is not implemented, you can go to the local health administrative department approved the establishment of the township health hospitals above the hospitals.
Participants whose medical relations are in the city and who have an emergency in a foreign city or province shall follow the above provisions.
5. Scope of Medical Expenses
Sporadic reimbursement of medical expenses incurred by a participant who seeks medical treatment in a foreign province or city in accordance with regulations shall be carried out in accordance with the provisions of the city's basic medical insurance for diagnostic and treatment items, medical service facilities and the scope of medication. If local medical insurance regulations are provided, the reimbursement can be made with reference to the relevant local regulations, but not in accordance with the regulations of both regions at the same time.
When reimbursement of medical expenses is made on a piecemeal basis, the deduction of funds from the individual account, the criteria for the outpatient and emergency outpatient deductible section, and the starting standard and maximum payment limit shall be implemented in accordance with the relevant standards of the medical insurance year as shown on the date of the special receipt for medical expenses at the time of applying for piecemeal reimbursement.
6. Period of Sporadic Reimbursement
Participants should apply for reimbursement of medical expenses at the neighboring municipal or county health insurance centers within 3 months from the date of the receipt of medical expenses issued by the hospital. The city, district and county health insurance centers will not accept medical expenses beyond 3 months.
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