Notice on the Issuance of the Implementing Rules of Guangzhou Urban Residents' Basic Medical Insurance
Spike Labor and Social Medicine [2008] No. 7
Labor and Social Security Bureau of all districts and counties, and all relevant units:
The Bureau, in accordance with the Trial Measures for the Basic Medical Insurance for Guangzhou Urban Residents (Spike Government Office [2008] No. 22) Article 22 of the authorization of the provisions of the "Guangzhou urban residents of basic medical insurance implementation rules". Hereby issued to you, please comply with the implementation.
Guangzhou Municipal Bureau of Labor and Social Security
July 18, 2008
(Contractor's Office: Medical Insurance Division, Contact Tel: 83330864)
Guangzhou Urban Residents' Basic Medical Insurance Implementing Rules
According to the "Trial Measures for Basic Medical Insurance for Urban Residents of Guangzhou City" (穗府办〔2008〕 No. 22, hereinafter referred to as the "Trial Measures"), the "Trial Measures" will be issued on July 22, 2009, and the "Basic Medical Insurance for Urban Residents" will be implemented in accordance with the provisions of Article 22 of the Trial Measures. No. 22, hereinafter referred to as the "Trial Measures"), the implementation rules are formulated.
I. Registration and Payment of Fees
(1) Handling of Registration
Departments of Labor Security, Civil Affairs, Disabled Persons' Federation, and Education of each district set up registration points in each street (town) Labor Security Service Center, Civil Affairs Office, Disabled Persons' Federation, and child-care institutions and schools within the jurisdiction of each district, according to the distribution of the inhabitants' residences. Urban residents (hereinafter referred to as "residents") in the city's medical insurance co-ordination area (including the administrative districts of Yuexiu, Haizhu, Liwan, Tianhe, Baiyun, Huangpu, Nansha, and Luogang Districts) shall apply for registration in the following ways:
Minors with urban household registration in the city (meaning residents who have not reached the age of 18 before June 1 of the current year) shall be registered in the following ways. Minors (residents who have not reached the age of 18 before June 1 of the current year), non-employed residents, and elderly residents shall choose on their own or through their agents to go to the labor security service center of any street (town) in the city to register for the insurance;
School students of various types of schools in the city, and minors of urban registration in the city who are enrolled in child-care institutions shall be unified by the schools and institutions in which they are enrolled for the registration of insurance;
Among the above residents (hereinafter referred to as the "residents"), the registration of insurance is handled as follows p>Among the above residents, the city's minimum subsistence guarantee recipients, low-income families in need, and government-supported persons housed in social welfare institutions go to the social affairs (civil affairs) offices of their respective streets (towns) to register for the insurance.
Severely disabled persons in the city go to their respective streets (towns) to register for the insurance.
(2) Participation registration information
1, the insured residents fill in the "Guangzhou Urban Residents' Basic Medical Insurance Participation Declaration Form", and apply for registration with the following information:
(1) Non-employed residents, elderly residents, and students enrolled in all types of higher education, secondary vocational and technical schools and technical schools on a full-time basis should provide the original household registration book and ID card, (The copy of the household register includes the first page of the name of the head of the household and the current page of the insured person, the same below);
(2) Minors, students studying full-time in primary and secondary schools should provide the original and copy of the household register, of which newborns born within three months should also provide the original and copy of the Birth Certificate;
(3) Foreign students should provide the original and copy of their passports when they apply for insurance;
(4) Foreign students should provide the original and copy of their passports when they apply for insurance. Original and photocopy;
2. If a participant chooses to entrust a bank to transfer the payment of residents' medical insurance premiums, he/she should provide the designated bank passbook with a photocopy, the original and photocopy of the ID card of the passbook's owner, and fill out and sign the Authorization for Entrusting a Bank to Automatically Transfer Payment of Social Insurance Premiums in accordance with the prescribed format. Registered participants who have not completed the procedure of entrusting the bank to make automatic transfer payments will go to the branch of the bank entrusted by the municipal local tax department to pay the premiums on their own.
3. In addition to the above information, the following residents are also required to provide appropriate information:
(1) low-income families in difficulty are required to provide the "Guangzhou Low-income Families in Difficulty Certificate";
(2) urban minimum subsistence guarantee recipients are required to provide the "Guangzhou Minimum Subsistence Guarantee for Urban Residents";
(3) rural minimum subsistence guarantee recipients are required to provide the "Guangzhou Minimum Subsistence Guarantee for Urban Residents";
(3) rural minimum subsistence Guarantee recipients must provide the Minimum Subsistence Guarantee Receipt Card for Rural Residents of Guangzhou City;
(4) Persons with severe disabilities must provide the Disabled Person's Certificate.
(3) Collection and Review of Residents' Personal Information
The labor security service centers of each street (town) are responsible for the collection and verification of the personal insurance information of minors, non-employed residents, elderly residents, children in childcare institutions, and school children, and send the registration information to the social insurance fund management centers of the districts in which they are located for review on a weekly basis; the social insurance fund management centers of the districts will receive the information within 10 days after receiving the information and send it to the social insurance fund management centers of the districts in which they are located for review. The district social insurance fund management center will review and print the "Guangzhou Urban Residents' Basic Medical Insurance Individual Levy Approval Sheet" (hereinafter referred to as the "Approval Sheet") within 10 working days upon receipt of the information, which will then be distributed by the above registered institutions to their insured persons.
The civil affairs department of each street (town) is responsible for the collection, verification and preliminary examination of the personal information of its registered participants, and submits it to the District Civil Affairs Bureau for review before the 20th day of each month; the Civil Affairs Bureau of each district sends the results of the examination of the eligibility of participants for individual financing to the Social Insurance Fund Management Center of the district where it is located before the 23rd day of each month; the Social Insurance Fund Management Center of the district examines and prints the Approved Sheet within 10 working days of receipt of the information The district social insurance fund management center will review and print the Approved Sheet within 10 working days after receiving the information, and then the civil affairs department of each street (town) will distribute the Approved Sheet to its insured persons.
The Disabled Persons' Federation department of each street (town) is responsible for collecting and checking the information of the insured persons with severe disabilities, and submits the review to the district Disabled Persons' Federation department by the 15th of each month after the first review of the eligibility of the insured persons for individual subsidy; the district Disabled Persons' Federation department will review the review by the 20th of each month and submit the summary to the district Civil Affairs Bureau, and the Civil Affairs Bureau will send the result of the review of the eligibility of the insured persons for individual subsidy to the social insurance fund administration center of the district where they are located by the 23rd of each month. The District Social Insurance Fund Management Center will review and print the Approved Sheet within 10 working days of receiving the information, and then the Disabled Persons' Federation Departments of the streets (towns) will distribute the Approved Sheet to their insured persons.
For participants who are not accepted for registration and whose audits are not passed, each registration department issues a letter of notification that they will not be enrolled in residents' medical insurance.
Residents of the provincial, municipal and district public medical management departments responsible for the management of family members of the coordinated medical care are not enrolled in the insurance for the time being.
The last two working days of each month the registration organizations suspend the registration business.
(4) Starting and ending time of the insurance year
Residents' basic medical insurance premiums are collected on an annual basis. The period from July 1 of the current year to June 30 of the following year is an insurance year.
A medical insurance relationship is established after a resident enrolls and is valid for the current insurance year.
(V) Collection of Insurance Premiums
Residents' basic medical insurance premiums are collected by banks on behalf of local tax authorities. The specific collection operations are specified in the collection agreement signed between the local tax authorities and the banks.
(6) Payment Methods and Payment Periods
Residents who have registered for the insurance shall pay the premiums with the Approved Sheet within the specified period of time at the collection units commissioned by the local tax authorities. Residents who are enrolled for the first time are required to pay from 3 to 23 of the month following the month of enrollment, and those who are continuously enrolled in the new year are required to pay from 3 to 23 of June each year.
People whose contributions are subsidized by the social medical assistance fund shall pay the premiums with the audit confirmation from the Municipal Civil Affairs Bureau on the objects of subsidy and the amount to be subsidized by the social medical assistance fund as the participation and payment of the premiums.
(VII) Collection of Residents' Basic Medical Insurance Premiums
Residents' basic medical insurance premiums collected by the local tax department shall be transferred in full to the financial account of the Residents' Basic Medical Insurance Fund in the same month, and shall be reconciled with the Municipal Social Insurance Fund Management Center (hereinafter referred to as the Municipal Fund Center), the Municipal Medical Insurance Service Management Center (hereinafter referred to as the Municipal Medical Insurance Center) and the Municipal Bureau of Finance on a regular basis.
The Municipal Fund Center sends the data sheet of social medical aid subsidy to the Municipal Civil Affairs Bureau before the 10th day of each month, and the Municipal Civil Affairs Bureau sends it to the Municipal Medical Insurance Center before the 20th day of the same month after reviewing and confirming the data sheet.
City fund center approved all levels of government contributions to the individual has been accounted for participants and social medical aid subsidies to the government should be funded amount, sent to the Municipal Medical Insurance Center. The Municipal Medical Insurance Center summarizes the amount of governmental subsidies payable at all levels and the amount of social medical aid subsidies payable on a monthly basis, and applies for appropriations from the Municipal Bureau of Finance, which is liquidated on an annual basis.
The Municipal Bureau of Finance will transfer the subsidized funds from all levels of governments and social medical assistance funds to the special account of the Resident's Basic Medical Insurance Fund. The Municipal Civil Affairs Bureau, the Municipal Medical Insurance Center and the Municipal Finance Bureau regularly reconcile their accounts.
Two, changes in participation, change of information
(H) renewal procedures
People who have participated in the residents' medical insurance, the renewal of the new year does not need to re-apply for registration procedures, according to the provisions of the payment of urban residents' basic medical insurance premiums, the residents of the medical insurance treatment is automatically renewed.
(IX) Stopping Procedures
If you need to stop the medical insurance relationship with the residents, you must fill in the "Registration Form for Stopping Urban Residents' Basic Medical Insurance" by the participant (guardian), and apply for the stopping procedures to the department of registration before the end of May of the current year.
Participants who have not declared their termination of insurance by the end of May of the current year and have not paid any contributions for the new year will be automatically terminated at the end of the new year.
(J) Handling of Data Change
If the basic data of a participant such as his/her name, ID card number, household relationship and personal status needs to be changed, he/she has to fill in the form of "Change of Personal Data of Guangzhou Urban Residents' Basic Medical Insurance" and go back to his/her original registration department to handle the change procedures.
If a child in daycare or a student in school leaves the school, graduates, transfers to another school or enrolls in a new year, and continues to participate in the residents' medical insurance in the new year, and if the basic information needs to be changed, the daycare institution or the school should go to the social insurance fund center of the district in which it is located to apply for the change procedures.
Three, insurance voucher management
(XI) the management of social medical insurance card
Guangzhou urban residents medical insurance card (hereinafter referred to as "residents' medical insurance card") as a participant in medical treatment and medical insurance related business vouchers, by the Municipal Medical Insurance Center unified management. Resident medical insurance card refers to the Guangzhou urban workers medical insurance card issued by the way to deal with.
The residents' medical insurance card also has the financial function of an ordinary savings card.
Street (town) labor security service agencies, child care institutions, schools, district civil affairs departments, district disability associations, after the 19th day of the month following the first registration of participants, with the relevant information to the medical insurance agency in the district where the application is made to receive the residents' medical insurance card, and before the end of the month, the card will be distributed to the participants who have paid the premiums for that month.
(XII) Use of the social health insurance card
The resident's health insurance card can only be used by the participant himself/herself, and may not be lent to others, and any medical expenses incurred by illegal use will be borne by the participant himself/herself after verification.
When a resident's medical card is lost or remade, the certificate of loss or the receipt of the remade card will be used to replace the resident's medical card.
(xiii) Usefulness of insurance vouchers
Participants who go to designated medical institutions for medical treatment must present valid medical insurance vouchers and valid identification documents; before they present valid medical insurance vouchers, medical expenses incurred in medical treatment shall be borne by the participant himself/herself.
If a participant is admitted to the hospital in an emergency or is unconscious due to coma, etc., and cannot present the medical insurance certificate on the spot, his/her relatives shall make up for the certificate within three working days of his/her admission to the hospital.
When a participant registers for hospitalization due to childbirth or termination of pregnancy in accordance with the provisions of the family planning policy, he/she must also present the original valid document approved by the family planning department.
Fourth, the management of medical treatment
(xiv) The management and use of the Resident Medical Insurance Outpatient Medical Record and the Record Book of Medical Treatment in Other Places
The Municipal Medical Insurance Center uniformly prints the "Outpatient Medical Record of Guangzhou Social Medical Insurance" (referred to as the "Outpatient Medical Record of Resident Medical Insurance") and the "Record Book of Medical Treatment in Other Places" (referred to as the "Record Book of Medical Treatment in Different Places"), and the participants are required to submit the documents of outpatient medical treatment in the designated medical institutions in Guangzhou. The specific methods of use shall be separately stipulated by the Municipal Medical Insurance Center.
(15) Management of hospitalization, outpatient specific items and outpatient treatment of designated chronic diseases
The management of hospitalization, outpatient specific items and outpatient treatment of designated chronic diseases of the residents' medical insurance participants at the designated medical institutions in the city shall be carried out in accordance with the relevant provisions of the city's employee medical insurance system.
(16) Management of general outpatient (emergency) visits
General outpatient (emergency) visits refer to outpatient (emergency) visits other than outpatient specific programs and designated chronic disease visits.
Among the social insurance designated medical institutions that can use the city's health insurance information system to record outpatient (emergency) fees, school students and minors choose a community health service organization (except for community health service organizations set up by second- and third-tier medical institutions in the main office, hereinafter the same) or the medical institution of the school they are attending and one other medical institution, and elderly residents choose a community health service organization. as the selected medical institution for their outpatient (emergency) medical treatment.
School students and minors are entitled to outpatient (emergency) treatment at the designated hospitals for the corresponding specialties. The specific designated hospitals and specialties will be announced separately by the Municipal Health Insurance Center.
Each social security year, the participant will go through the procedure of confirming the selected medical institution when he/she makes the first general outpatient (emergency) treatment at the selected medical institution. The participant or his/her guardian fills in the "Registration Form for Selected Medical Institutions for General Outpatient (Emergency) Clinic" in the "Resident Medical Insurance Outpatient Medical Record" and affixes a recent front-facing, bareheaded, one-inch color photo; the medical institution verifies the participant's information and affixes a special label on the corner of the photo; the participant's current visit to a medical institution is confirmed to be the medical institution of his/her choice for the current year after the visit has been accounted for and settled.
After confirming the selected medical institution, no change is allowed during the year. However, if a participant has moved his/her household registration or has changed the qualifications of the designated medical institution, or if a minor or a student has changed schools, he/she can go to the offices of the Municipal Health Insurance Center to change the selected medical institution.
(17) Management of medical treatment in a different place
1. The following cases of medical treatment in a different place are entitled to the corresponding basic medical insurance treatment for residents in accordance with the provisions of the Trial Measures:
(1) Participants who have resided for more than half a year in a different place within the country, and who have completed the formalities for long-term medical treatment in a different place, and who have been hospitalized in the selected medical institutions in a different place, or who have received outpatient treatment of a specified item and designated chronic disease treatment;
(2) Referral to public medical institutions outside the city for hospitalization upon approval;
(3) Emergency hospitalization or emergency hospitalization in a different place;
(4) School students returning to the place of domicile during the summer and winter vacations, or during the suspension of school due to illnesses, or during the internship period in a local public medical institution for hospitalization, outpatient specific items and designated chronic disease treatment or emergency treatment. .
The medical expenses incurred for medical treatment in other places that do not fall within the above scope will not be paid by the Resident Medical Insurance Fund.
2. The management of residents' medical insurance for medical treatment in other places shall be based on the relevant provisions of the basic medical insurance for urban workers in the city.
The insured who reside in the same foreign place within the territory for more than half a year shall be managed according to the long-term foreign medical treatment, and shall go through the procedures of long-term foreign medical treatment, use the Record Book of Foreign Medical Treatment, and standardize the record of foreign medical treatment information.
Other cases of medical treatment in other places are managed as temporary medical treatment in other places.
V. Treatment of Residents' Medical Insurance
(XVIII) Scope and Standard of Treatment
The scope and standard of treatment of residents' medical insurance shall be implemented in accordance with the relevant provisions of the Trial Measures.
Elderly residents shall be reimbursed 50% of the basic medical expenses incurred in outpatient (emergency) consultations at their selected medical institutions;
School students and minors shall be reimbursed 70% of the basic medical expenses incurred in general outpatient (emergency) consultations at their selected community medical institutions or at their school's medical institutions, and 70% of the basic medical expenses incurred in general outpatient (emergency) consultations at other medical institutions, designated hospitals and specialized medical institutions of their choice shall be reimbursed at their selected community medical institutions and designated hospitals.
Participating patients will have to pay directly to the designated medical institutions.
The residents' medical insurance fund will not pay for general outpatient (emergency) medical expenses incurred by the insured in non-selected medical institutions or non-designated hospitals and specialties. However, outpatient basic medical drug expenses incurred by school students during winter and summer vacations, or when they take a break from school due to illness, or during internships abroad, for emergency medical treatment at public medical institutions in other places, will be reimbursed sporadically by the Residents' Medical Insurance Fund according to the payment ratio of 40%.
(XIX) Convergence of Treatment Across Insurance Categories
Urban residents who switch to urban flexibly employed persons' medical insurance during the period of participation in residents' medical insurance can continue to enjoy residents' medical insurance treatment during the months in the waiting period for flexibly employed persons' medical insurance in the year of the residents' medical insurance for which they have already made contributions.
(xx) Accumulation of the annual maximum payment limit
If a resident changes the type of social health insurance he or she participates in with the change of status in a social security year, the medical expenses incurred during the period of participation in the different types of insurance will be accumulated separately and the annual maximum payment limit will be calculated separately.
(xxi) Contribution period
The contribution period of urban residents participating in the residents' medical insurance shall not be accumulated as the contribution period of the employees' basic medical insurance in the city.
Fund Payment
(22) Scope and Standard of Fund Payment
The scope of medical expenses paid by the Residents' Medical Insurance Fund to the insured shall be in accordance with the relevant provisions of the Drug List, Diagnostic and Therapeutic Items, and the Scope of Medical Service Facilities and the Standard of Payment of the Urban Employees' Basic Medical Insurance in the city.
Hospitalization medical expenses incurred in connection with childbirth or termination of pregnancy in accordance with the provisions of the family planning policy shall be implemented in accordance with the scope of items and catalogs of medical expenses paid by the maternity insurance of the city's enterprise workers and the standards stipulated in the Trial Measures.
(XXIII) Circumstances in which the Fund will not pay
The residents' medical insurance fund will not pay for the medical expenses incurred under any of the following circumstances:
1. Unapproved medical treatment in a medical institution other than the designated medical institutions for social insurance in Guangzhou;
2. Suicide or self-inflicted injuries (except for mental illness);
3, Fighting, alcoholism, drug addiction and other injuries or illnesses caused by crime or violation of the Law of Punishment for Public Security Administration;
4. Traffic accidents, accidents, medical accidents, or medical expenses explicitly covered by Workers' Compensation Insurance where the responsibility for the compensation of medical expenses has already been assumed by the other party;
5. Medical treatment in foreign countries or in Hong Kong or Macao Special Administrative Regions, as well as in Taiwan;
6, Other cases that are not paid by the state, province or city.
VII. Management of Designated Medical Institutions and Settlement of Medical Expenses
(24) Management of Designated Medical Institutions
The management of designated medical institutions for residents' medical insurance shall be carried out in accordance with the relevant provisions of the city's basic medical insurance system for urban workers, and the Municipal Medical Insurance Center shall sign a supplemental agreement with each of the designated medical institutions.
(25) Settlement of Medical Expenses
Basic medical expenses incurred by participants for hospitalization, outpatient specific items and treatment of designated chronic diseases shall be settled in accordance with the corresponding settlement method of the city's urban workers' basic medical insurance.
The basic medical expenses incurred by participants such as school students and minors who are hospitalized in designated medical institutions in the city in accordance with the regulations shall be settled in accordance with the method of service items.
School students, minors and elderly residents are required to pay for general outpatient (emergency) medication expenses, which are paid by the medical insurance fund, the hospitals will first keep the accounts, and then the Municipal Medical Insurance Center will settle the expenses with the designated medical institutions according to the service items, the "per capita limit per annum" or the "average monthly limit", and so on. The hospitals will first keep the accounts, and the Municipal Medical Insurance Center and the designated medical institutions will settle the accounts according to the service items, "annual per capita limit" or "monthly average limit". The specific method is determined in the medical service agreement.
(XXVI) Retroactive Resident Medical Insurance Benefits
The scope of retroactive resident medical insurance benefits:
Newborns who enroll and pay resident medical insurance premiums for the year of their birth within 3 months (inclusive) of birth, the basic medical expenses incurred in medical treatment from the time of birth to the month of the payment of the premiums;
School children who enroll and pay the premiums by October 31 of the year
The basic medical expenses incurred from July 1 of the year to the month of payment for those who enrolled in the insurance before October 31 of the year;
The basic medical expenses incurred from July 1 of the year to the month of payment for those who enrolled in the insurance before August 23 of the year after the implementation of the Trial Measures.
The settlement method of the retroactive medical insurance treatment for residents:
1. The retroactive medical treatment for hospitalization is operated in the way of "the patient pays the deposit first and the hospital delays the settlement".
Beginning July 1, 2008, the designated medical institutions for residents who have participated in or ready to participate in the medical insurance but not yet entitled to treatment of the city's household registration inpatient hospital for the discharge of the bill, after consultation with the insured patients can be charged with the hospitalization of the amount of medical fees and the amount of the deposit.
After the discharged patients can enjoy the treatment of residents' medical insurance, since August 1, 2008, with residents' medical insurance card, valid ID documents, deposit receipts, and discharge certificates to the original inpatient hospitals to apply for the medical fee billing and settlement.
The designated medical institution will, after checking the medical insurance information system to confirm the participant's identity and treatment, carry out the procedures of hospitalization registration and discharge settlement for the participant and return the deposit equal to the amount of the medical fee to be credited immediately.
2. Emergency detention and other outpatient specific items within the validity period of the approval, the designated chronic disease medical treatment retroactive, according to the inpatient medical treatment retroactive way to deal with.
3, general outpatient (emergency) medical treatment retroactively in accordance with the "selected medical institutions on behalf of the sporadic reimbursement" approach.
Since October 31, 2008, the selected medical institutions began to accept applications for reimbursement of outpatient (emergency) basic medical expenses incurred by the insured in their medical institutions during the retroactive period.
The steps for the selected medical institutions to handle outpatient (emergency) medical fee reimbursement on behalf of the participants are as follows:
(1) The participants go to the selected medical institutions where the medical fees were incurred to fill in the "Application Form for Retroactive Treatment of Outpatient (Emergency) Medical Fees of Guangzhou Municipal Urban Residents' Medical Insurance" (hereinafter referred to as the "Application Form"), and present the residents' medical insurance card, a valid ID document and the "Medical Insurance Outpatient Medical Record", and at the same time submit the original residents' medical insurance card and the medical insurance outpatient medical record. The application form also includes a copy of the front and back of the Resident Medical Insurance Card, the original medical receipt (invoice), and a breakdown of the medical expenses.
Selected medical institutions will immediately review and confirm the information, stamp the Application Form, and submit the receipt to the participant.
(2) The selected medical institutions will summarize the information of the zero-reporting application for the retroactive treatment of residents' outpatient (emergency) consultation on a monthly basis, and fill in the Summary of Retroactive Reporting of Outpatient (Emergency) Consultation Medical Expenses of Selected Medical Institutions of Guangzhou Municipal Urban Residents' Medical Insurance (hereinafter referred to as the "Declaration Form").
Selected medical institutions will send the zero-reporting application information submitted by the participants and the Declaration Form to the office of the Municipal Health Insurance Center every month to centrally process the zero-reporting of outpatient (emergency) medical expenses.
(3) After the Municipal Health Insurance Center accepts and examines the application information for zero-reimbursement of outpatient (emergency) treatment retroactively, it will directly transfer the expenses that belong to the residents' health insurance fund to the individual settlement account of the bank of the participant's residents' health insurance card.
(27) Cross-Social Security Year Settlement
Continuous inpatient and outpatient treatment for specific items across social security years shall be subject to segmented settlement according to the social security year, and the medical expenses incurred shall be accumulated separately according to the social security year, with only one inpatient starting payment standard.
(xxviii) Cross-insurance Settlement
If a participant's health insurance treatment changes during hospitalization (e.g., if the resident's health insurance is converted to the employee's health insurance, or if the employee's health insurance is converted to the resident's health insurance), he/she is required to apply for segmented settlement, and the standard of the medical treatment is calculated in accordance with the relevant standards that he/she should be entitled to at the time of the settlement and is only charged with the standard of the starting payment for one hospitalization.
VIII. Sporadic Reimbursement of Medical Expenses
(29) Scope of Sporadic Reimbursement of Medical Expenses
The following expenses belong to the scope of sporadic reimbursement of medical expenses:
1. The approved medical expenses incurred by the participant in hospitalization or emergency treatment in a designated medical institution for hospitalization or emergency treatment in a non-city social insurance institution for emergency medical treatment due to emergency treatment of the participant's illness or rescue, as well as for special needs of the participant's illness. Medical expenses;
2. Basic medical expenses that have been advanced by the insured person due to objective reasons that cannot be settled by the designated medical institution and the designated medical institution is unable to retroactively record the system to settle the expenses;
3. Basic outpatient (emergency) medical expenses within the scope of the retroactive medical insurance treatment for the residents that are reimbursed sporadically by the designated medical institution on behalf of the residents;
4. Basic outpatient (emergency) medical expenses that meet the requirements of Basic medical expenses within the scope of off-site medical treatment as stipulated in Article (17) of these Rules.
(30) Sporadic Reimbursement Methods
Participants shall apply to the Municipal Health Insurance Center for sporadic reimbursement within three months from the date of settlement of medical expenses with the following information.
1, the original resident medical insurance card and a copy of the front and back;
2, an itemized list of medical expenses (or a list of manual records certified by a medical institution);
3, a receipt or invoice for medical charges printed by the finance and taxation department;
4, a Medical Insurance Outpatient Medical Record or a Record Book of Medical Treatment in a Different Place, and other information.
When the information is complete, the Municipal Medical Insurance Center will complete the audit and settlement within 40 working days and transfer the expenses paid by the Resident Medical Insurance Fund to the individual settlement account of the bank of the Resident Medical Insurance Card of the participant; if it is a difficult case or requires on-site verification and other special circumstances, it will take no more than 90 working days to complete the audit and settlement.
The Municipal Medical Insurance Center shall inform the participant once to make up the missing information when it confirms that the information is incomplete; and shall inform the participant within 40 working days if it makes a conclusion of non-payment after the audit.
Nine, other
(31) social medical assistance management
Civil affairs department confirmed by the residents in difficulty, enjoying the residents' medical insurance benefits, and then enjoy the social medical assistance in accordance with the relevant provisions of the relevant provisions of the Municipal Civil Affairs and other departments.
(32) the implementation of the starting point of time and limitation
The implementation of the rules shall come into force from the date of publication, valid for three years. The expiration of the effective period, according to the implementation of the law to assess the revision.
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