If the insured person is hospitalized (including outpatient specific treatment), he can go to the local designated medical institution for inpatient and outpatient specific treatment, and the medical expenses shall be paid in advance by the individual. Within 1 month from the date of discharge, the insured unit shall apply for reimbursement to the municipal medical insurance center with the following information;
1) copy of the front and back of the medical insurance card;
2) A copy of the confirmed application form for medical treatment in different places;
3) The discharge certificate or medical expenses of specific outpatient items must be accompanied by the diagnosis certificate of a copy of the Mente Application Form approved by the Municipal Medical Insurance Center (except for emergency observation);
4) Detailed list of medical expenses;
5) Official receipt of medical expenses (with the signature of the reimbursement person on the back);
2. If the insured suffers from acute diseases while traveling, studying or visiting relatives in other places (excluding Hong Kong, Macao and Taiwan), he can go to the local public hospital for medical treatment, and the outpatient medical expenses shall be borne by the insured; The expenses incurred by the approved hospitalization (including emergency observation and treatment) shall be paid by the insured in cash, and the unit manager shall apply for sporadic reimbursement to the municipal medical insurance center with the following information:
1) certificate of the insured unit;
2) Copies of the front and back of the medical insurance card;
3) discharge or diagnosis certificate;
4) Detailed list of medical expenses;
5) Medical expense invoice (followed by the name of the reimburser);
6) copy of hospitalization medical records.
Extended data:
Institutional audit
Establish a cooperative mechanism of medical insurance agencies, and implement mutual management of medical treatment in different places for insured persons living in different places in the local area. The review and payment of benefits are still handled by the insurance agency. The insured person is hospitalized in different places and entrusts the local medical insurance agency to audit the system.
The procedures and requirements of management can be negotiated by medical insurance agencies in advance, gradually unified, and the national medical insurance management measures in different places will be introduced in time, making entrusted management the normal responsibility of medical insurance agencies.
It is suggested that the Ministry of Labor and Social Security should set up national identification codes for local medical insurance agencies, set up e-mail boxes according to the codes, write address books, and gradually establish a national medical insurance intranet to facilitate the contact and exchange between local medical insurance agencies. ?
Hospital audit
At the beginning of the reform of the medical insurance system, most places stipulated that the designated hospital system should be implemented when going abroad for medical treatment. Medical insurance agencies can gradually establish fixed-point relations with qualified medical institutions in different places, and sign contracts to clarify the rights and obligations of both parties.
It is stipulated that residents living in different places and medical staff transferred to hospitals should register with the designated hospital medical insurance office when seeking medical treatment, and the staff of the hospital medical insurance office should conduct on-site audit against medical insurance, examination and approval procedures for going abroad for medical treatment, examination and approval procedures for designated hospitals in different places and other materials.
When necessary, communicate directly with the entrusted medical insurance agency by telephone, fax, email, etc. Apply for registration to the designated hospital medical insurance office.
On the one hand, it is conducive to hospitalization audit, on the other hand, it can ask the medical insurance office to assist in handling related matters, so as to facilitate the insured to seek medical treatment. Medical insurance agencies should strictly control the transfer to non-designated hospitals in different places for medical treatment.
Entrust the medical insurance agency to make a custody request by telephone, e-mail, letter, etc.,-provide relevant information,-entrust the medical insurance agency to establish management files,-arrange personnel to conduct on-site audit, and-feed back information to the entrusted medical insurance agency.
Entrusted medical insurance agencies or designated hospitals to conduct on-site audit, generally handled by two or more staff members, to check whether the witness cards are consistent, conditional can take photos of medical staff hospitalized in different places.
When taking photos, one staff member will take photos with the patient at the bedside, and another staff member will take photos, and at the same time, he can take photos of the surgical incision or symptoms of the insured. Photos can be transmitted to the entrusted medical insurance agency by e-mail and stored in the computer management system for reference and verification.
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