1, direct settlement for medical treatment in different places
The medical expenses incurred by the insured in the designated hospitals in the co-ordination areas where I have successfully filed can be directly settled and reimbursed in real time.
Procedures for filing in different places:
(1) Take the medical insurance card to the counter of the social security bureau service outlets and apply to the counter staff for inter-provincial medical treatment;
(2) fill in the application form for medical treatment in different places and go through the registration formalities;
(3) Going to designated medical institutions in different places shall be put on record, and the designated medical institutions have passed the examination and approval, and the record in different places is successful.
2. Emergency manual reimbursement in different places
For the insured who have not gone through the direct settlement and filing of cross-provincial medical treatment in different places, the emergency medical expenses incurred in designated hospitals in different places can be reimbursed manually after returning to the insured place.
Under any of the following circumstances, the individual shall pay the medical expenses in full, keep the receipt, prescription, diagnosis certificate and other materials issued by the hospital, and submit them to the district medical insurance agency for manual reimbursement:
(1) The insured fails to issue a card after enrollment, fails to hold a card in the emergency department, presses the card at the time of hospitalization and discharge settlement, replaces the social security card, and goes to the doctor during the unit's arrears;
(2) The designated pharmacies failed to make real-time settlement due to problems in the medical insurance system, which met the payment conditions of the medical insurance fund;
(3) medical expenses for medical treatment in different places that meet the requirements of medical insurance in the insured place.
The settlement of medical insurance in different places needs to meet the following three requirements:
1, the insured person has gone through the inter-provincial medical registration and filing as required;
2. Hospitals seeking medical treatment in different places have opened direct settlement for medical treatment in different places across the country;
3. You must have a social security card with complete information to see a doctor, including the new rural cooperative medical system and the medical insurance card for urban residents.
To sum up, medical insurance in different places can also be reimbursed, and materials such as discharge summary need to be sorted out before reimbursement.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.