1. The first step is to open the "Alipay" APP in your hand.
2. The second step is to enter the main interface of Alipay, and then click on the "medical insurance" option on the left side.
3. Finally, click on the "dual-channel service" in the online health insurance service.
By the State Talking Drugs designated hospitals State Talking Drugs medical insurance responsible physician (specific list consult the designated hospitals) diagnosis meets the scope of the State Talking Drugs medication (i.e., in line with the scope of payment of the drug limit), by the responsible physician to fill out the "insured patients "dual-channel" management and payment of medication alone drug application form, the responsible physician and his or her The responsible physician and his/her medical institution will report to the medical insurance department for the record through online in real time.
After the medical insurance department's audit (generally 1 working day), the insured person, with the e-prescription or paper prescription issued by the responsible physician and holding the medical insurance e-voucher (or a valid ID card or medical insurance card), can settle the payment by card directly in the designated medical institutions and one designated retail pharmacy of the State Drug Administration in his/her own name, which he/she has selected at the time of the filing.
The costs incurred for the use of national medicines in non-national medicine designated medical institutions shall be settled by the insured person at his/her own expense.
Note: insured patients to enjoy the health insurance treatment period, must be regularly to the state drug insurance responsible physician review assessment, the responsible physician to fill out the "dual-channel" management of insured patients and separate payment for the use of medicines assessment form" and sign to confirm that according to the results of the assessment of the timely adjustment of the drug program. The maximum time for review and assessment is not more than one year, and the specific interval is determined by the responsible physician. The Assessment Form will be stamped by the hospital's medical insurance office and submitted to the medical insurance department for record via online in real time. After review and assessment, insured patients who do not meet the criteria of "dual-channel" for clinical diagnosis and use of nationally recognized medicines will no longer be entitled to the corresponding treatment. If the review is not conducted in accordance with the prescribed time limit, the relevant medical insurance treatment shall be suspended or canceled. Not through the state drug "dual-channel" record of the insured person in the use of the relevant drugs at their own expense to settle the full amount.
I. What is the dual-channel management of the state drug?
"Dual-channel", as the name suggests, refers to two ways to buy drugs, namely through designated medical institutions and designated retail pharmacies. It was introduced to solve the problem of the last kilometer of the country's negotiated drugs on the ground.
Two, which drugs are included in the "dual-channel" management?
At present, Suzhou has 150 kinds of drugs into the dual-channel management, the following 118 kinds of drugs, the process of purchasing drugs and treatment changes, of which the first batch of August 1, 2021 - December 31, 2021 *** counting 83 kinds, the second batch of January 1, 2022 to the present *** counting 35 kinds.
Third, what are the changes in the treatment enjoyment of the insured?
The state drugs included in the "dual-channel" management are divided into two categories. One is the drugs that are included in the scope of outpatient special drugs, and the other is the drugs that are specially guaranteed for the outpatient clinic. Different categories of drugs are directly related to the treatment of insured persons. If the participants of the first category that is included in the scope of special outpatient drug users. Originally has been handled for the record of the special, need to synchronize for the national drug "dual-channel" filing. Treatment enjoyment in accordance with the provisions of the special program treatment standards.
If the insured person is a user of the second category of drugs mentioned above, i.e., the special outpatient coverage of nationally-talked drugs, then the "dual-channel" filing should be done. Then after applying for the "dual-channel" record, in the "dual-channel" designated medical institutions and designated retail pharmacies to buy "dual-channel" drugs, in line with the provisions of the medical insurance settlement of the costs, the urban workers' basic medical insurance co-ordination fund payment. The basic medical insurance fund for urban workers pays 90% and the basic medical insurance fund for urban and rural residents pays 80% of the costs, with no starting line, and the costs are directly included in the medical insurance fund. Within a medical insurance settlement year, the total payment limit of "dual-channel" medication costs is 100,000 yuan, and the costs exceeding the limit will be settled according to the policy of treating regular Class B medicines in the medical insurance catalog.
Four, how to enjoy the "dual-channel" treatment of the state drug in the foreign medical treatment?
(1) The insured persons who have applied for the provincial record and have the qualification of "dual-channel" medication, if they purchase the medicines included in the scope of outpatient medication, they can choose one designated medical institution for national medication in the list of national medication selected by the province where they seek medical treatment to settle the cost of national medication in accordance with the corresponding treatment standard by directly transferring the card to settle the cost of national medication in accordance with the regulations; or Choose one designated pharmacy for national negotiated medicines, and the cost of national negotiated medicines in conformity with the regulations shall be advanced by the insured person first and then go to the medical insurance agency of the place where he/she is insured for piecemeal reimbursement.
If you purchase outpatient special protection medicines, you can choose one designated medical institution and one designated pharmacy for national medicines from the list of national medicines selected by the province where you are seeking medical treatment, and the expenses incurred for national medicines in accordance with the regulations will be settled directly by credit card in accordance with the corresponding treatment standards, or the insured person will make advance payment and then go to the local health insurance agency for sporadic reimbursement.
(2) The insured persons who have applied for cross-provincial record and have the qualification of "dual-channel" medication can choose one second-level and above cross-provincial network settlement designated medical institution as the "dual-channel" designated medical institution in the place of medical treatment, and the insured persons who have the qualification of "dual-channel" medication can choose one second-level and above cross-provincial network settlement designated medical institution in the place of medical treatment as the "dual-channel" designated medical institution. Dual-channel" medical expenses incurred in accordance with the provisions of the 64 kinds of medicines included in the management of the door at the same time to see the direct card settlement, the remaining 55 kinds of cash advances need to be made, and then go to the participating local health insurance agencies in accordance with the provisions of the treatment standard for sporadic reimbursement.
(3) without the referral of foreign medical record, has determined the qualification of the medication of the insured person, in a foreign place in line with the provisions of the "dual-channel" costs in accordance with the original provisions of the settlement ratio of 80% of the settlement. Participants who have not determined the qualification of medication are not entitled to "dual-channel" treatment.
Legal basis：
《National Health Insurance Negotiated Drugs "Dual-channel" Management and Separate Payment of Drugs Regulations (for Trial Implementation)
Article IX
Participating patients who use the "Dual-channel" management and separate payment of drugs (for trial implementation). Dual Channel" Management and Separate Payment of Medicines Process includes application registration, acceptance for filing, purchase and collection of medicines, settlement of expenses, review and evaluation, etc.
(Article 9)
(A) application for registration. The insured patients by the national talk about medicine medical insurance responsible physician diagnosis, need to use the "dual-channel" management and separate payment of medicines, by the responsible physician and his medical institutions in real time through the online or to assist the insured patients offline to the medical insurance department to submit the record.
The materials for the record include the Application Form for "Dual-channel" Management and Separate Payment of Medicines for Insured Patients (hereinafter referred to as the "Application Form", Attachment 1), diagnostic materials for diseases (including test reports, discharge summaries, outpatient medical records, etc.), and the electronic vouchers for medical insurance (or valid ID cards, social security cards, etc.).
(2) Acceptance of the record. Each district city health insurance agency to verify the completeness of the application materials, within one working day for completion. Incomplete materials, should be a one-time notification of additional improvements.
(C) the purchase of drugs. The insured patients with the electronic or paper prescription issued by the responsible physician, holding the electronic voucher of medical insurance (or valid ID card, social security card) to the selected State Talks about drugs designated pharmaceutical institutions to purchase drugs.
The state drug designated pharmaceutical organizations should establish the whole process of drug quality and safety supervision and traceability mechanism. State drug designated retail pharmacy sales of injectable state drug, should be by the state drug designated retail pharmacy in accordance with the requirements of the cold chain transportation and other free delivery to the designated medical institutions, a clear drug handover, the person responsible for safekeeping, according to the number of drug handover order and prescription requirements, inspection and acceptance of qualified injection use, to ensure the safety of clinical use of medicines. State talks about the drug designated medical institutions should be real-time uploaded to the local health insurance department of the insured patients to buy drugs time, the amount of drugs prescribed and other information.
(D) cost settlement. Insured patients in outpatient or hospitalization, the use of "dual-channel" management of separate payment of drugs, in accordance with the province and the municipalities set the proportion of drug payment settlement, lower than the current basic medical insurance settlement treatment, in accordance with the principle of the higher; the use of "dual-channel" management of non-separate payment of medicines. If the treatment is lower than the current basic medical insurance settlement treatment, it will be implemented according to the principle of the highest; for the non-individually paid medicines under "dual-channel" management, the relevant treatment will be implemented in accordance with the current regulations of each region. The treatment of insured patients in the same municipalities should be consistent with the treatment for purchasing medicines at designated medical institutions and designated retail pharmacies. The insured patients only pay the part that should be borne by the individual in accordance with the provisions of the integrated fund of medical insurance part of the payment by the medical insurance agency on a monthly basis with the state drug designated medical institutions, designated retail pharmacies in accordance with the provisions of the settlement.
(E) Review and assessment. The insured patients enjoy medical insurance treatment period, must be regularly to the state drug insurance responsible physician review assessment, review results in the form of "insured patients" dual-channel "management and separate payment of drug use assessment form" (hereinafter referred to as the "assessment form", Annex 2) form of record, signed by the responsible physician to confirm, and based on the results of the assessment of timely adjustment of the use of medication Program. The insured patients who do not meet the criteria for the use of nationally recognized drugs for clinical medical diagnosis after review and assessment will no longer be entitled to reimbursement under the medical insurance. If the review is not conducted in accordance with the stipulated time limit, the relevant medical insurance treatment shall be suspended or canceled. The maximum time for review and assessment shall not exceed one year, with specific intervals to be determined by the responsible physician.
Article 10: In principle, insured patients shall choose one designated medical institution as the designated medical institution for their consultation and treatment, and they may also choose one designated retail pharmacy as the designated retail pharmacy for the purchase and collection of their medicines.
Article XI of the insured patients within the province for medical treatment using "dual-channel" management and separate payment of medicines incurred in accordance with the provisions of the cost of direct settlement of medical treatment in a different place; non-direct settlement, by the individual cash advances, back to the place of the sporadic reimbursement. The implementation of cross-provincial medical record insured patients, the use of "dual-channel" management and separate payment of drugs, according to the relevant provisions of the national cross-provincial medical settlement, but also by the insured place of health insurance agencies in accordance with the provisions of the reimbursement.