Chapter 1 General Provisions

Article 1 is to conscientiously implement the "Tangshan Urban and Rural Resident Basic Medical Insurance Implementation Measures" and "Tangshan Urban and Rural Resident Basic Medical Insurance Outpatient Special Disease Management Measures" ", standardize the medical management of the basic medical insurance for urban and rural residents in our city, ensure the basic medical needs of insured residents, and formulate these implementation rules based on the actual work.

Article 2: These implementation rules apply to insured residents seeking medical treatment in the coordinated area and in other places.

Article 3 Designated medical institutions should fully implement the "Medical Service Agreement of Tangshan Basic Medical Insurance Designated Medical Institutions", be honest and law-abiding, promote medical ethics, and increase punishment for violations of laws and disciplines in accordance with relevant regulations on integrity risk prevention and control. The intensity of punishment.

Article 4 Insured residents should use social security cards to seek medical treatment in designated medical institutions. If you have not received a social security card, you must provide your resident ID card. If you have not applied for a resident ID card, you must provide a copy of the household registration page, personal page and guardian's ID card.

Article 5 Resident medical insurance implements designated medical treatment and online settlement. Medical expenses incurred by insured residents at designated medical institutions are directly settled. If direct settlement for medical treatment in other places has not yet been achieved, the individual will first advance the payment, and then the agency will go to the medical insurance agency in the insured place to handle the medical expense reimbursement procedures that meet the regulations.

Insured residents who are diagnosed by experts as suffering from chronic myelogenous leukemia or gastrointestinal stromal tumor will be prescribed targeted therapy drugs for designated management, and will choose designated medical institutions designated by the Charity Federation for prescription. After the individual makes an advance payment, the agency will go to the medical insurance agency in the insured place to handle the reimbursement procedures.

Article 6: The medicines taken after discharge should be oral Western medicines, Chinese patent medicines or Chinese medicine preparations related to the treatment of inpatient diseases. The dosage of oral Western medicine and Chinese patent medicines shall not exceed the 5-day dosage, and the dosage of Chinese medicine in decoction pieces shall not exceed the 7-day dosage.

Outpatient examinations and treatment items after discharge shall not be included in inpatient medical expenses.

Chapter 2 Coordinates the Management of Medical Treatment in the Region

Article 7 If insured residents go to other designated medical institutions for examination during hospitalization or outpatient treatment for special diseases in designated medical institutions, they should Handle external inspection registration and filing procedures. The expenses for inpatient external examinations that meet the regulations are included in the current hospitalization medical expenses and are noted in the temporary medical order; the expenses for outpatient external examinations for special diseases are paid by designated medical institutions. Anything beyond the scope of external inspection filing items will not be included.

Section 1 Hospitalization Management

Article 8 Insured residents who go to designated medical institutions for hospitalization should go through medical insurance hospitalization procedures.

Article 9 Designated medical institutions should give priority to drugs and medical items within the scope of the basic medical insurance catalog. When using self-paid drugs, diagnosis and treatment items that are beyond the scope of the catalog, and medical materials that exceed the price limit of medical insurance payment, the consent and signature of the insured resident or his family members must be obtained in advance.

Designated medical institutions should provide a list of medical expenses to insured residents who are hospitalized every day, and the insured residents themselves or their family members should check it.

Article 10 Designated medical institutions should promptly handle discharge settlement procedures for insured residents who have completed hospitalization and reached discharge standards, print settlement documents and medical expense summary tables, and submit them in the Urban and Rural Resident Basic Medical Insurance Settlement System Accurately and standardizedly enter information such as admission date, discharge date, disease diagnosis, department name, attending physician name, medical record number, etc.

If you want to supplement hospitalization expenses, you should choose the correct type of supplement.

Article 11 If an insured resident completely loses the ability to take care of himself, upon application by himself or his family members and a doctor’s certificate, he must fill in the "Tangshan Basic Medical Insurance Family Hospital Bed Application Form", file it with the medical insurance department of the designated medical institution, and report After registering with the medical insurance agency in the insured area, you can go through the procedures for a therapeutic home hospital bed. The time limit for setting up home beds is one month. If it is necessary to continue the establishment due to illness, it should be re-applied.

Article 12 If an insured resident undergoes two-way referral, the transfer out of the designated medical institution shall be registered with the two-way referral form, and the relevant information shall be entered before settlement. If insured residents are transferred to a designated medical institution for hospitalization procedures within 2 days from the actual date of discharge, the minimum payment standard will not be calculated twice.

Section 2: Outpatient Coordination and Medical Treatment Management

Article 13: Insured residents should coordinate outpatient clinics in designated township health centers and administrative villages that are integrated into integrated management in the insured area. Visit primary medical institutions such as clinics and community health service centers.

Insured college students should seek medical treatment at the school hospital or a medical institution designated by the school.

Article 14: Outpatient coordination and designated medical institutions should strictly abide by the "Prescription Management Measures" and other regulations to standardize medical management.

Section 3 Outpatient Medical Management of Special Diseases

Article 15: Special outpatient diseases in the medical insurance settlement system of designated medical institutions are divided into Category A, Category B, Category C, and Category D. The diseases with reserved benefits under the original Urban Resident Basic Medical Insurance and New Rural Cooperative Medical Care will be merged into Category C.

Article 16 The original basic medical insurance for urban residents and the new rural cooperative medical outpatient special diseases are merged and managed. The limits of the merged diseases are the same as the corresponding limits of the diseases after the merger. At the same time, the "Cumulative Limits of Diseases" will be implemented. Annual Limit Standards".

Article 17 If the diseases identified by the insured residents involve multiple categories, prescriptions will be issued separately. During settlement, the diseases in the corresponding categories will be selected and entered in sequence, and settled separately.

Clinicians should treat illnesses according to illness, use drugs rationally, and should not use the limit unexpectedly.