First, under what circumstances do the insured persons of basic medical insurance need to go through the formalities of medical treatment in different places?
Urban workers' basic medical insurance and urban (township) residents' basic medical insurance, in any of the following circumstances, shall go through the formalities of medical treatment in different places.
(1) Resettlement of retirees in different places;
(two) long-term residence or long-term work and study in different places for more than 6 months;
(three) due to illness needs to be transferred to the designated medical institutions in the insured areas for diagnosis and treatment.
Persons in the above-mentioned situations (1) and (2) are referred to as "long-term overseas personnel".
2. How to settle or reimburse the medical expenses incurred by the insured in different places?
In addition to emergency, the insured person must first go through the formalities of medical treatment in different places, and the medical expenses incurred in different places can be directly settled or reimbursed. There are two ways to settle medical expenses in different places:
1. Direct settlement by credit card: When the insured holds the unified social security card of Jiangsu Province (hereinafter referred to as the "social security card") for medical treatment in the networked medical institutions in different places, they can directly settle the account by credit card. The part of medical expenses that should be borne by individuals shall be paid directly by individuals in cash or personal accounts, paid by medical insurance pooling funds, and settled by medical insurance agencies and hospitals.
2. Advance before reimbursement: the insured person pays the medical expenses in full first, and then submits them to the medical insurance agency of the insured place for reimbursement with the disease diagnosis certificate and expense invoice.
Third, how to go through the formalities of medical treatment in different places?
1. Long-term migrant workers: Step 1, the insured person carries his social security card (Jiangsu Unified Social Security Card) and his ID card (the agent needs to carry his agent's ID card), fills in the registration form of basic medical insurance for medical treatment in different places (which can be downloaded from the human resources and social security website of the insured place), and goes through the formalities at the medical insurance agency in the insured place; The second step is to choose the settlement method for medical treatment in different places (① direct settlement by credit card; (2) Advance before reimbursement); The third step, if you pay first and then reimburse, choose 2-3 designated hospitals; Step 4, the medical insurance agency in the insured place checks and uploads the insured person's information to the remote medical treatment settlement platform.
2. Medical personnel transferred to other places due to illness: Step 1, the insured person carries his/her social security card, his/her ID card (the agent needs to carry his/her agent's ID card) and the filing form for the transfer of basic medical insurance to other places issued by the local designated medical institution, and goes through the formalities at the medical insurance agency in the insured place; The second step is to choose the settlement method for medical treatment in different places (① direct settlement by credit card; (2) Advance before reimbursement); Step 3, select 1 hospital; Step 4, the medical insurance agency in the insured place checks and uploads the insured person's information to the remote medical treatment settlement platform.
4. How to settle the medical expenses of sudden illness (emergency) in different places?
1. If the insured person goes out temporarily and goes to a different place for medical treatment due to sudden illness, the individual shall pay the medical expenses in full first, and then submit the emergency diagnosis certificate and expense invoice to the medical insurance agency in the insured place for reimbursement;
2. When a person who has gone through medical treatment in a different place goes to a medical institution that has not been filed or connected to the Internet for medical treatment due to sudden illness, the individual will pay the medical expenses in full first, and then return to the medical insurance agency in the insured area for reimbursement with the emergency diagnosis certificate and expense invoice.
5. What are the medical treatment rules after going through the medical treatment procedures in different places?
1. Persons who have gone through the medical record in different places must seek medical treatment in the networked medical institutions or designated medical institutions selected at the record place, before they can directly settle accounts or submit reimbursement by credit card;
2. The social security card of medical personnel in different places can only be used at the filing place, not at the insured place.
3. At present, the medical expenses of outpatient and inpatient treatment in different places in the province can be settled directly by credit card; Inter-provincial medical treatment in different places can only be settled directly by credit card. Retail pharmacies are temporarily unable to settle accounts.
6. What treatment does the insured enjoy when seeking medical treatment in different places?
1, insured persons seek medical treatment in different places in the province, and medical insurance benefits implement the insured policy;
2. When the insured goes to different provinces for medical treatment, the scope of medical insurance catalogue and relevant regulations (including drug catalogue, diagnosis and treatment items, consumables and medical service facilities standards) specified in the medical treatment place shall be implemented, and the deductible line, reimbursement ratio and maximum payment limit of basic medical insurance shall be implemented.
7. What should the insured do if he needs to change relevant information?
1. If a long-term migrant needs to change or return to his/her place of residence, he/she should go to the medical insurance agency in the insured place to change or cancel his/her medical record in another place.
2. If the medical personnel transferred to other places due to illness want to change the medical institution, they should make changes in accordance with the provisions of the insured place and file a new medical institution.
8. What are the regions and medical institutions in our province that realize direct settlement of medical treatment in different places?
At present, all cities, counties and districts in Jiangsu Province are networked with the settlement platform for medical treatment in different places in the province, realizing direct settlement of medical treatment in different places. There are 1 199 networked medical institutions seeking medical treatment in different places. Among them, tertiary medical institutions 138, secondary medical institutions 267, and primary and undecided medical institutions 794.
The specific catalogue can be found in official website and Jiangsu Human Resources and Social Security Network. Official website address:
Nine, how is the progress of direct settlement of medical treatment in different places in our province?
At present, the direct settlement of medical treatment across provinces and different places in China has been rapidly promoted, and the hospitalization expenses of retirees, long-term residents in different places, permanent residents in different places and referral personnel in different places can be directly settled.
Jiangsu province 13 cities completed the docking with the national telemedicine system, and opened 267 inter-provincial telemedicine networking medical institutions. As long as the provinces and cities where you live or seek medical treatment are connected to the national telemedicine system, you can realize the direct settlement of telemedicine.
Whether the insured in our province goes to the province for medical treatment, or the insured from outside the province comes to our province for medical treatment, it is necessary to go to the medical insurance agency in the insured place to go through the relevant procedures for cross-provincial medical treatment in advance.
Ten, Jiangsu Province, the municipal medical insurance agencies in different places to contact the medical business.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.