However, there is a premise. The premise of using the balance of medical insurance personal account in different places is to register in the medical insurance center in advance. Only after filing, the account balance of the medical insurance card can be used in different places. If there is no record, users can't use the balance of medical insurance personal account to buy medicine in different places.
The direct settlement process of medical insurance in different places is as follows:
1, put on record. Before the insured person goes to a different place for medical treatment, he can go through the off-line channels such as the medical insurance service platform and the window of the insurance agency to go through the formalities for medical treatment in a different place;
2. At the selected point, after the insured completes the medical records in different places, all inter-provincial networked designated medical institutions opened at the filing place can enjoy the inter-provincial direct settlement service for hospitalization expenses;
3. Holding a card for medical treatment, when the insured person is registered in hospital, discharged from hospital and settled in outpatient service, he should produce valid certificates such as medical insurance electronic certificate or social security card to directly settle the medical expenses for diagnosis and treatment.
The scope of use of the medical insurance card is as follows:
1. Designated pharmacies: Medical insurance consists of two accounts: individual account and overall account. Personal accounts can be used to buy medicines at designated pharmacies, and are mainly responsible for the payment of outpatient expenses and hospitalization expenses paid by individuals. The overall account managed by the medical insurance center pays the expenses incurred by the insured who meet the local medical insurance reimbursement;
2. Designated hospitals: When you go to a designated hospital for medical treatment, you can show your medical insurance card to prove your enrollment and registration. Individuals do not need to pay first and then reimburse, and can directly settle the medical insurance reimbursement with medical insurance and hospitals. Only when the account is settled can the self-funded part be paid with the balance of the medical insurance card or cash. There is a deductible line for hospitalization reimbursement (the standard of deductible line is generally 65438+ 00% of the average annual salary of employees in the city last year), which means that the deductible line needs to be paid by itself, and the part exceeding the deductible line can be reimbursed according to local medical insurance regulations. The reimbursement rate varies from place to place, and different projects in different hospitals are different, about 80%.
To sum up, medical insurance is gradually realizing provincial overall planning, and different cities in the province can use medical insurance cards for reimbursement. In other provinces, because medical insurance has not achieved national overall planning, people who often travel abroad after retirement or are resettled in different places can register at the medical insurance center, so that even if they see a doctor in different places, the medical expenses after consumption can be reimbursed at the place where medical insurance is located.
Legal basis:
Article 64 of People's Republic of China (PRC) Social Insurance Law
Social insurance funds include basic endowment insurance fund, basic medical insurance fund, industrial injury insurance fund, unemployment insurance fund and maternity insurance fund. In addition to the basic medical insurance fund and maternity insurance fund combined accounting, other social insurance funds are accounted for separately according to social insurance types. Social insurance funds implement a unified accounting system throughout the country.
The social insurance fund is earmarked for special purposes, and no organization or individual may occupy or misappropriate it.
The basic old-age insurance fund will gradually implement national overall planning, and other social insurance funds will gradually implement provincial overall planning. The specific time and steps shall be stipulated by the State Council.