Medical treatment in different places can be simply defined as the medical treatment behavior of the insured outside the insured place. In social medical insurance coverage, "off-site" generally refers to other areas in China other than the co-ordination area where the insured person is insured, and "seeking medical treatment" refers to the insured person's medical treatment behavior.
"Off-site medical treatment" is mainly divided into three situations.
First, one-time medical treatment in different places, including emergency treatment during business trips and tourism, leads to the problem that medical expenses cannot be settled in time.
Second, short-term and medium-term mobility. The jobs are not in the insured places for medical treatment in different places, including the personnel stationed in various places of the unit and the local employees of the stationed institutions. Another situation is that the whole unit is in a state of mobility, such as the medical care for employees in the construction industry, and the problems arising are either that they cannot participate in medical insurance or that they have to pay medical expenses in advance.
The third is the medical care of retirees who have been resettled in different places for a long time. Including those whose registered permanent residence is moved from the place of work to the place of resettlement after retirement, and those who rely on their children to move in without registered permanent residence. On the surface, the problem is that the medical settlement is not timely and inconvenient, and the personal burden is heavy. In essence, the medical treatment in a safe place is often better than that in the insured place, and the resettlement personnel feel that the medical treatment is unequal.
Reasons for declaration
1. Due to the limitation of local medical level, some critically ill patients and patients whose long-term treatment effect was not obvious in local designated medical institutions were transferred to other places for medical treatment.
2. Some people participate in endowment insurance and medical insurance as freelancers in the local area, but they usually work in other places, and when they are sick, they seek medical treatment at their workplace.
3. After retirement, some employees miss their homeland and go back to their hometown to provide for the aged, and seek medical treatment in the local hospital in their hometown.
4. Some enterprises have contracted projects abroad or set up marketing agencies in other places, and their employees have been working and seeking medical treatment in other places for a long time.
Declaration standard
1, retired insured persons resettled in different places;
2. The insured who has lived in the same place in China for more than half a year after retirement;
3. Insured who work in different places in China.
Declaration procedure
1. The insured can only seek medical treatment in designated medical institutions in different places after going through the confirmation procedures for medical treatment in different places. The amount of his personal medical account can be withdrawn through any business outlet of the medical insurance card, which is used to support the expenses of outpatient general diseases and the expenses of drug purchase and dispensing in pharmacies. 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. When the insured goes to other places (excluding Hong Kong, Macao and Taiwan) for business trip, study or visiting relatives, 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.
According to the Guiding Opinions on Further Improving the Settlement of Medical Expenses for Medical Treatment in Different Places of Basic Medical Insurance
Three, standardize the direct settlement of medical treatment in different places in the province.
All provinces should, in accordance with the unified national norms, establish and improve the provincial-level settlement platform for medical treatment in different places, coordinate and support the exchange of information such as medical personnel information, medical service data and expense settlement data among provinces, and carry out direct settlement of medical treatment in different places within the province through the platform.
The human resources and social security departments of all provinces should strengthen the guidance of medical insurance policies in all co-ordinate areas, establish a unified information standard library of drug catalogues, diagnosis and treatment items and medical service facilities in accordance with national requirements, and improve the settlement methods and handling procedures related to medical treatment in different places. It is necessary to improve the management of designated medical institutions and establish and maintain a database of designated medical institutions that supports direct settlement of medical treatment in different places. The list of designated medical institutions shall be announced to the public.
The medical insurance benefits of medical personnel in different places shall be subject to the policy of the insured place. All co-ordination areas should establish standardized methods for submitting medical treatment in different places. After the eligible insured person agrees to seek medical treatment in a different place, the agency in the insured place will transmit the personnel information to the agency in the different place through the provincial platform. The agency in the place of medical treatment is responsible for providing handling services for medical personnel in different places, supervising relevant medical service behaviors, and timely and truthfully transmitting relevant information to the agency in the insured place.