I. Basic information of the applicant
Name:
Contact information:
Certificate Type: Resident Identity Card
Certificate number:
Please click to enter the picture description (maximum 18 words).
Second, the agency notice.
(1) Names of government services
The insured persons of basic medical insurance seek medical treatment in different places for the record (for the record of resettling retirees in different places);
The insured persons of basic medical insurance seek medical treatment in different places for the record (the resident persons in different places for the record);
The insured persons of basic medical insurance seek medical treatment in different places for the record (for long-term residents in different places).
(two) the contents of the certification (certification materials)
Record of retirees in different places: proof of residence (can be residence permit, temporary residence permit, or my local household registration book);
Filing of permanent residents in different places: proof of work in different places (it can be the dispatch certificate of the work unit in the insured place, the proof of work unit in different places or the work contract);
Long-term residence record in different places: proof of residence (such as my local household registration book, residence permit, real estate license, rental contract).
(3) Basis for setting certification items
Notice of the Department of Finance of Ministry of Human Resources and Social Security on Doing a Good Job in Direct Settlement of Medical Expenses of Inpatients in Different Provinces for Medical Treatment with Basic Medical Insurance (Ministry of Human Resources and Social Security Fa [2065 438] 120); Notice on Establishing the Coordination Management Mechanism of Inter-provincial and Inter-provincial Medical Settlement Business of Basic Medical Insurance (No.33 of Medical Insurance Office [2065438+09]); Notice on printing and distributing the service rules for medical treatment in different places in Jiangsu Province (Jiangsu Medical Insurance Regulation 1 [2065438]No.).
(4) Inform the applicable object of the commitment.
The applicant for this certification can choose whether to use notification commitment instead of certification. If the applicant is unwilling or unable to make a commitment, it shall submit the required certification materials.
(5) the way of commitment
The certificate is in the form of a written commitment. If the applicant is willing to make a commitment, it shall submit the original letter of commitment signed by himself to the agency.
This certificate must be made by the applicant, not on his behalf.
(VI) Liability for false promises
To conceal the real situation and provide false promises to handle related matters, the following treatments are made respectively:
1. If the applicant does not meet the processing conditions, it shall stop the application or treat it as invalid.
2. Record the false promise information into personal credit files, and incorporate it into the municipal credit information system to implement joint punishment. When the promisor handles other medical insurance-related matters, the notification commitment system is no longer applicable.
3. Whoever defrauds social insurance benefits by means of fraud, forgery of certification materials, etc., shall be ordered to return the defrauded social insurance benefits according to Article 88 of the Social Insurance Law of People's Republic of China (PRC), and shall be imposed a fine of more than two times and less than five times the amount defrauded.
4 suspected of committing a crime, transferred to judicial organs.
Three. The applicant promises that
I (ID number:) handle the business of filing medical treatment in different places. I am unable to provide proof of residence in a different place for personal reasons, and I guarantee that I meet the requirements for handling this business (address of residence in a different place:), and the information provided is true, accurate, complete and effective, and all legal responsibilities arising therefrom shall be borne by me.
I promise that I have read and agreed to the promise stipulated by the insurance place, and the information provided is true. I am willing to accept the information, enjoy the inquiry and verification, and bear the relevant responsibilities.
Organizer (signature, fingerprint): MM DD YY.
Personal medical insurance record commitment letter is an important document. The following are the main points and precautions when writing:
Key points:
1. Define personal information: including name, ID number, contact information, etc.
2. Commitment content: explain in detail the willingness and commitment to voluntarily participate in medical insurance filing in different places.
3. Ensure authenticity: Ensure that the information and commitments provided are true and accurate.
4. Date of signing: Sign the letter of commitment and date it.
Precautions:
1. Concise language: express commitment in clear and concise language, and avoid using vague or ambiguous words.
2. Abide by laws and regulations: The promised content must comply with relevant medical insurance policies and laws.
3. Protect personal privacy: ensure the confidentiality of personal information and don't disclose sensitive information in the letter of commitment.
4. Save the backup: after writing, keep the electronic version or paper backup of the commitment letter.
The above are the main points and matters needing attention in writing a personal commitment letter for medical insurance filing in different places, hoping to help you.
Personal medical insurance record commitment letter is an important document. The following are the main points and precautions when writing:
Legal basis:
Seventh doctors can organize and participate in medical associations and other related industry organizations and professional academic groups according to law.