2. Settlement process of medical insurance hospitalization expenses: the settlement personnel will immediately review the hospitalization expenses data uploaded by designated hospitals every day. Check the data with the hospital before 5th of each month, and distribute it before 10 every month after it is accurate.
3. Referral and transfer: those who meet the conditions for referral and transfer will be referred and transferred step by step, and the designated hospital will make a decision within three days. By the attending physician to fill in the "referral application form", the hospital medical insurance office signed opinions and reported to the municipal medical insurance management center medical settlement department for the record. In the transfer area, the medical expenses will be transferred to the hospital for settlement; In case of transfer, the medical expenses shall be paid in advance by the individual, and settled in the transfer hospital with relevant procedures after discharge.
4, retired cadres must hold a card to the designated hospital for medical treatment, medical expenses that belong to individuals at their own expense are settled by themselves and medical institutions, and expenses that belong to the scope of medical insurance payment are settled by hospitals, and settlement data are uploaded in real time. Before 5th of each month, the medical institution shall reconcile with the medical insurance center, and 90% of the payment amount shall be paid before 10, and the other 10% deposit shall be paid before the end of the following year 1 according to the assessment results. The monthly balance settlement shall be implemented, and the part exceeding the monthly control index shall be the year-end total balance.
5. Retired cadres placed in different places shall be settled at the medical insurance center at the end of each quarter 10 to 20: 00 with medical IC cards, valid reimbursement vouchers and related procedures. A receipt corresponds to a prescription reimbursed by an outpatient clinic, and the report of the test results should be checked. The reimbursement for hospitalization needs to provide a detailed list of hospitalization expenses, disease diagnosis and a copy of hospitalization medical records issued by designated medical institutions.
6. When there is a balance in the personal account of retired cadres at the end of the year, 50% of the balance will be collected in cash at the local medical insurance center on June 65438+1October 3/0 of the following year, and the other 50% will be transferred to my personal account for the next year.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Twenty-third employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.