Second, the method of medical treatment in a different place
The long-term medical treatment in a different place referred to in these measures, you need to go to the city health insurance agency for medical treatment in a different place to confirm the formalities in advance. Long-term work or study in a different place of employment participants by the employer to apply for, other participants by the unit or individual to apply for.Third, the application for medical treatment in a different place need to prepare materials
Employers and individuals should apply for medical treatment in a different place should provide the following information: (a) long-term residence in a different place should be provided: 1. Residence for the domicile of the location, to provide a copy of the relevant certificate of domicile; the place of residence of the location is not the domicile of the place of residence, to provide the place of residence of the police station, street, neighborhood (or neighborhood), the police department, the street, the street, the street, the neighborhood (or neighborhood), the street, the street, the neighborhood, the neighborhood, the neighborhood, the neighborhood, the neighborhood (or neighborhood). Police station, street, neighborhood (village) committee issued by the original certificate of residence for more than six months or a copy of the temporary residence permit; 2. A copy of the applicant's identity card, entrusted to another person should also be issued by a copy of the identity card of the entrustee. (B) is a long-term work, study should provide: participant and the employer signed a copy of the valid labor contract and the "Guangzhou Basic Medical Insurance Participants Declaration of the roster of medical treatment in other places," or the unit of the proof of study and related materials (must be stamped with the official seal of the unit). (C) depending on the situation should provide the relevant documents: 1. In the employer's off-site branch of the work, you need to provide the branch of the unit's organizational code certificate or a copy of the tax registration certificate (must be stamped with the official seal of the unit). 2. Employer for non-labor dispatch nature, but not set up branches in other places, you need to provide the employer's project (construction) contract, the purchase or lease of counters or proof of housing (such as rental agreement, purchase contract, rental contract, etc.) copies (must be stamped with the official seal of the unit) and other materials, and provide a written explanation of the situation. 3. The employer is non-labor dispatch nature, frequent changes in off-site workplaces or no fixed off-site work sites (such as overseas construction, navigation, etc.), you need to provide the project (construction) contract, project documents, overseas positions and personnel to provide copies of the supporting materials (must be stamped with the official seal of the unit). 4. The employer is the nature of labor dispatch, you need to provide the employer's business license, qualification documents, signed with the employing unit of the dispatch agreement and a copy of the list of dispatched personnel (must be stamped with the official seal of the employing unit), employing unit of the contract issued by the off-site project, employment agreement and a copy of the post and personnel abroad to prove the material (must be stamped with the official seal of the unit). 5. Human resources service agencies for the employer for social security business, the relevant application in addition to the above provisions, but also to provide the employer entrusted the agency to act as an agent of the employer for the social security business of copies of relevant information.Four, the relationship between the stopping conditions
The following circumstances, the participant's confirmation of the validity of the medical treatment in a different place will be terminated accordingly, the participant or the employer should be timely to the city health insurance agency for the cancellation of the medical treatment in a different place: (a) the participant returned to the city of long-term residence, work; (b) the end of study to return to the city; (ii) the end of study to return to the city; (b) the end of study to return to the city; (c) the end of study to return to the city; (d) the end of study to return to the city; (d) Change of circumstances, no longer belong to the city's social health insurance provisions of the scope of medical treatment in a different place.Fifth, the designated hospital for medical treatment in a different place
Long-term medical treatment in a different place, the insured person must choose a designated medical institution in a different place. You can choose one to three different medical institutions within the prefecture-level city of your residence as your medical institution. The selected medical institution must be examined and stamped by the selected medical institution and the local medical insurance agency, and then go to the city medical insurance agency for confirmation. In principle, no change will be made within 6 months after the selection. For reasons such as the need for medical treatment, moving to a new place of residence, or changing the name or level of the medical institution in the other place, you can go to the city's medical insurance agency with the appropriate information to apply for change procedures.If a participant who works abroad for construction or sailing is not able to choose a medical institution in a different place, the employer should issue a certificate and submit it to the local medical insurance office for confirmation.
Sixth, outpatient specific program related matters
Participants in the outpatient specific program (hereinafter referred to as outpatient special) or outpatient designated chronic disease (hereinafter referred to as outpatient slow) treatment in foreign medical institutions, according to the outpatient special or outpatient slow treatment of the relevant provisions of the medical treatment, and in accordance with the following ways to handle the relevant formalities: (a) has not yet been designated in the city human resources and social security department designated designated point of care medical institutions. (a) the human resources and social security department designated designated medical institutions for outpatient special, outpatient slow treatment confirmation of the insured, should be selected in a different place of the corresponding medical institution "diagnosis of disease certificate" and outpatient special, outpatient slow application and other relevant information, in the city health insurance agencies and designated designated designated medical institutions for treatment confirmation procedures. (2) Participants who have already had their treatment confirmed at the designated designated medical institutions of the city's human resources and social security departments, should apply for a change in the designated designated medical institutions of the city's medical insurance agencies with the Diagnosis of Disease Proofs of the corresponding medical institutions selected in the other place, as well as the approved information on the medical treatment in the other place, and the information on the special medical treatment.Participants who have had their outpatient treatment confirmed by the designated designated designated medical institutions of the city's medical insurance can directly seek medical treatment at the corresponding off-site medical institutions.
Seven, on the local transfer to a different place of treatment
Where the city can be treated diseases and diagnostic and therapeutic programs have been carried out, in principle, can not be referred to outside the city. The city's designated medical institutions do not have the conditions for diagnosis and treatment of insured patients, need to be transferred to a medical institution outside the city hospitalization, must be two of the city's tertiary designated medical institutions expert consultation agreed by the designated medical institution attending physician to fill out the "Guangzhou social health insurance participants outside the coordinated area referral application form", by the deputy director of the staff or head of the department signed, medical (medical insurance) management department review and seal, reported to the medical insurance agency for approval. After the approval of the local medical insurance agency, the medical expenses incurred in the medical institution designated for referral will be reimbursed in accordance with the regulations. The approval of each referral outside the city is valid for six months.If a participant needs to be referred again during the period of out-of-town treatment, he/she should go through the referral procedures again.
Eight, foreign medical reimbursement regulations
1, approved by the approval of the foreign medical participants to meet the basic medical expenses, the city's health insurance agency in accordance with the city's basic medical insurance standards to give the appropriate treatment. The lump-sum fee for the general outpatient treatment for long-term out-of-towners is implemented in accordance with the relevant documents of the city's basic medical insurance. 2. Participants who have gone through the procedure of confirming the medical treatment in a different place, and the medical expenses incurred by the fixed-point (or designated) medical institutions in the coordinating area that cooperates with the settlement of medical expenses for medical treatment in a different place in the city are accounted for and settled by the fixed-point (or designated) medical institutions in accordance with the relevant regulations. The scope of the basic medical insurance catalog of medicines, diagnostic and therapeutic items and medical service facilities and their payment standards are implemented in accordance with the relevant provisions of the basic medical insurance of the place of medical treatment, and the treatment standards are paid in accordance with the relevant standards of the basic medical insurance of the city.Nine, the application for medical treatment in a different place successful people temporarily return to Guangzhou for medical treatment
has applied for confirmation of medical treatment in a different place of the insured person temporarily return to the city within the integrated area for medical treatment in the designated medical institutions in the emergency hospitalization observation and emergency hospitalization, in line with the provisions of the medical costs, by the participant to pay the medical costs and then apply for the reimbursement of sporadic medical expenses, other medical expenses will not be paid by the medical insurance fund. Other medical expenses will not be paid by the medical insurance fund. Participants who have gone through the procedure of confirmation of medical treatment in a different place, due to emergency or rescue in non-selected medical institutions in a different place need to be hospitalized for emergency observation or hospitalization, the relevant medical costs are paid by the individual advances, and meet the provisions of the medical expenses settlement to the municipal health insurance agency for incidental medical expenses reimbursement.Participants who have applied for special and slow treatment confirmation, temporary return to the city coordinating area for medical treatment, the reimbursement of incidental medical expenses for a continuous period of no more than six months.
Reimbursement of foreign medical insurance
I, the conditions of foreign medical insurance reimbursement
1, has been for the foreign settlement, visiting relatives, work and study abroad and other foreign medical registration procedures for the insured, in the foreign medical insurance designated health care institutions incurred in the medical costs of cash advances. The situation.2. Provincial-level participants agreed to transfer to Beijing and Shanghai health insurance designated medical institutions for medical expenses incurred in the case of cash advances.
The reimbursement rate of outpatient medical insurance (up to 90%)
1, the outpatient reimbursement rate General outpatient clinic does not set a starting line for all insured residents to enjoy general outpatient treatment. A medical insurance year, general outpatient clinic does not set a starting line, into the outpatient coordinated fund within the scope of payment of medical expenses reimbursement at a rate of 60%, the coordinated fund annual individual maximum payment limit of 400 yuan. 2, hospitalization reimbursement rate The longer the continuous participation in the reimbursement rate of the larger the insured residents to pay continuous contributions for every 5 years, the hospitalization reimbursement rate of the medical insurance fund increased by 5 percentage points, the cumulative total of not more than 10 percentage points. If you have been insured for 10 consecutive years since 2007, the reimbursement rate for hospitalization in a third-class, second-class and first-class hospital will be 70%, 80% and 90% respectively. 3, the second reimbursement rate "Second reimbursement" may also have "reimbursement" in the insured residents single hospitalization of medical costs, is the urban residents of the basic medical insurance fund within the scope of payment 'part of the basic medical insurance fund in the basic health insurance co-ordination. After the proportion of the basic medical insurance fund to pay, the personal burden of more than 8,000 yuan above the part of the funds of the major disease insurance for more than part of the proportion of 55% to give the "second reimbursement". The medical expenses incurred by insured residents for multiple hospitalizations in a year, after the basic medical insurance and "secondary reimbursement" payment, the individual's annual accumulated burden of hospitalization medical expenses (including compliance, reasonable out-of-pocket expenses) exceeds 25,000 yuan or more, by the funds of the major disease insurance for the exceeding part of the proportion of 55% to give the "reimbursement". "Reimbursement", the annual individual maximum payment limit of 250,000 yuan of major medical insurance funds. 4, reimbursement The maximum annual reimbursement of 370,000 yuan to participate in the city's urban residents health insurance residents, the annual payment limit of its basic health insurance is 120,000 yuan, the payment limit of 250,000 yuan of major medical insurance. Therefore, YINO Finance found that the participants can be reimbursed up to 370,000 yuan per year.Three, the process of reimbursement of foreign medical insurance
1, receive or download on the social security website, "the city's basic medical insurance to work, live in a different place, the situation of the declaration form" (hereinafter referred to as "declaration form"); 2, according to the provisions of the fill in, and by the field of social insurance (medical insurance) by the agency stamped recognized the "return"; 3, will be filled out, and by the foreign social insurance (medical insurance) recognized by the agency seal; 4, the basic health insurance, the basic health insurance, the basic health insurance is the most important thing to do. p> 3, will be filled out after the "declaration form" back to the division of responsibility for the social insurance agency audit, and to confirm. To apply for the province's medical card, the audit confirmed by the "declaration form" to the municipal social security center audit section for registration, and then to the social security card management section for the province's network of cards for the card procedures; 4, for the preparation of the individual social security card can not be used in the use of the insured; insured persons to return to have to be in the medical treatment should be canceled in the municipal social security institutions to the medical preparation of the social security card from the next day onwards.The principle of reporting any changes in the medical report and not reporting any changes in the medical report has been implemented.
Four, foreign medical insurance reimbursement required materials
1, a copy of the application form for foreign medical 2, the regular pharmacy invoices (State Administration of Taxation, the Ministry of Finance Supervision and the invoice listed on the details of the purchased medicines) or outpatient receipts of designated hospitals 3, the patient's own identity card and the agent's identity card 4, the person's bank passbook bank card Account number (except for rural credit unions) (foreign accounts need the name of the bank)Direction of development of medical insurance reimbursement
Yin Weimin, Minister of Human Resources and Social Security, said that the solution to the problem of direct settlement of medical care in different places, will be divided into three steps. The first step is to realize the direct settlement of medical treatment within the province. Statistics show that the largest proportion of provincial medical treatment. As of the end of 2016, China has 30 provinces to realize the provincial medical card settlement. The second step: in the first half of this year, to realize the direct settlement of hospitalization expenses for cross-provincial cross-location medical treatment for people who have retired and resettled in other places. Yin Weimin said: "the retired parents to the children's work place, in the other place directly can see the doctor settlement." The third step: before the end of this year, the realization of all eligible referrals for direct settlement of hospitalization expenses. According to the Ministry of Human Resources and Social Security, the national settlement system for medical treatment in different places has been on-line trial run at the end of 2016. In the trial run, 15 provinces have access to the system to start the pilot. The system is mainly for four types of people, namely: 1 retirees resettled in a different place, i.e., those who have settled in a different place after retirement and whose household registration has been moved to the place of settlement; 2 long-term residents living in a different place, referring to those who are living in a different place and meet the regulations of the place of insurance; 3 permanent staff in a different place, referring to the employer assigned to work in a different place and meet the regulations of the place of insurance; 4 permanent referrals for medical consultation in a different place, referring to those who are working in a different place and meet the regulations of the place of insurance; 4 permanent referrals for medical consultation in a different place. p> 4 referrals, refers to the participants in the referral provisions of the insured place. Previously, the medical expenses of the foreign clinic by the individual advance payment, until the end of the treatment, the person or his agent to take the bills to the health insurance center for reimbursement. After the realization of the direct settlement of medical insurance across provinces, the insured citizens do not need to pay the medical expenses (except for out-of-pocket expenses), and do not need to take the invoice for reimbursement, just take the social security card in the designated hospital. The reimbursement rate will be settled directly from the card, and the individual only needs to deposit the out-of-pocket funds directly to the card.Can rural medical insurance reimbursement?
Answer: Yes, the new rural medical field in the hospital within three days after hospitalization to take the hospital to confirm the diagnosis of the certificate to the new rural medical record, discharged within 10 working days can be reimbursed. Reimbursement with ID card, medical card, hukou, record registration form, hospital stamped payment details, hospitalization charges, copies of cases. However, the reimbursement rate is much lower than that of local doctors.How to apply for foreign medical insurance five steps to be clear
Medical insurance does not reimburse the scope of
1, self-medication (not designated hospitals for medical treatment or do not handle the referral order), purchased medicines, the public health care provisions of the medicine can not be reimbursed, and not in line with the medical expenses of the family planning. 2. Outpatient treatment fees, consultation fees, hospitalization fees, meals, companion fees, nutritional fees, blood transfusion fees (except for those with family blood reserves, which will be reimbursed in accordance with the relevant regulations), air conditioning fees, ambulance fees, special nursing fees and other expenses. 3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents. 4. Orthopedics, cosmetic surgery, dentures, prosthetics, organ transplants, named surgery fees, consultation fees, and so on. 5. Reimbursement within the scope, outside the limit. Note: The above are not covered by the rural medical insurance.Medicare drug reimbursement coverage
The drugs included in the basic medical insurance coverage are divided into two categories: Class A and Class B. The first category is the National Basic Medical Insurance (NBMI), and the second category is the National Health Insurance (NHI). Class A drugs are those that are basically standardized across the country and can guarantee the basic needs of clinical treatment. The costs of such drugs are covered by the basic medical insurance fund and are paid for in accordance with the basic medical insurance payment standards.Reimbursement for basic medical insurance diagnostic and treatment programs
Basic medical insurance diagnostic and treatment programs should meet the following conditions: (1) Clinical diagnosis and treatment must be, safe and effective, and the cost is appropriate; (2) Charges are set by the price department; (3) The designated medical institutions for the insured to provide the designated medical service within the scope.Reimbursement of basic medical service facilities
The reimbursement of basic medical insurance medical service facilities covers the living service facilities provided by the designated medical institutions which are necessary for the participants in the process of receiving diagnosis, treatment and care, including mainly the fees for inpatient hospitalization beds or outpatient (emergency) hospitalization beds.What diseases can be reimbursed by the urban health insurance
Sexual tumors, leukemia, uremia, liver transplantation, kidney transplantation, aplastic anemia, pulmonary heart disease combined with chronic heart failure, diabetes mellitus, rheumatoid arthritis, autoimmune diseases, hepatitis, cirrhosis of the liver, old myocardial infarction, chronic glomerulonephritis, Cerebral thrombosis, cerebral hemorrhage, hypertensive heart disease, femoral head necrosis, malignant tumors, nephrotic syndrome, post cardiovascular stenting, post cerebrovascular stenting, post-vascular stenting, schizophrenia, Parkinson's, myelodysplastic syndrome, true erythrocytosis, primary thrombocythemia, primary myelofibrosis, rheumatic heart valve disease, myasthenia gravis, hemophilia, and postoperative pituitary tumors.Urban and rural health insurance reimbursement diseases
A class of four diseases: malignant tumors, uremia, organ or tissue transplantation, hemophilia. Eight types of diseases in the second category: including leukemia, aplastic anemia, old heart attack, myelodysplastic syndrome, active hepatitis, stenting, nephrotic syndrome, autoimmune diseases.The process of reimbursement:
1. Bring the patient's ID card, two one-inch color photos, and the new rural medical card to the county cooperative management office for the referral filing procedures. 2, with the patient's ID card, NPPC medical card and referral record procedures to the referral hospital, for NPPC hospitalization procedures. 3. After being discharged from the hospital, the patient will be reimbursed with his/her ID card (or hukou), NHB medical card, a copy of his/her medical record, hospitalization statement (in the form of an invoice, if any), list of hospitalization expenses, and referral procedures for the record to the Office of the Joint Administration.Remarks:
1. Participating migrant workers who seek medical treatment at their workplaces can first seek medical treatment, and then go to the county cooperative management office to make up for the referral filing procedures during the hospitalization period or after being discharged from the hospital. 2, the unit must be the local New Agricultural Cooperative designated medical institutions, or not reimbursement. The catalog of Class B drugs is adjusted by provinces, autonomous regions and municipalities directly under the central government according to their own circumstances, which