How to handle social security referral procedures?

1, xx basic medical insurance outpatient referral certificate (hereinafter referred to as outpatient referral certificate) is issued by the attending doctor in the hospital, and then it is audited and stamped by the relevant departments of the hospital, and registered by the handling personnel.

2. When the insured person is hospitalized for the first time, he should go through the transfer formalities with his social security card (or medical insurance card) and outpatient referral certificate. Transfer to the hospital and keep the transfer certificate of the outpatient department.

3, outpatient referral certificate from the date of issuance, valid for 3 months. If it is necessary to continue to be transferred after more than 3 months, the insured should go to the community health service center (or a first-class medical institution) to go through the transfer procedures again.

4. The insured wants

After secondary and tertiary hospitals, you can still take a card to the community health service center (or a first-class medical institution) for medical treatment and settle medical expenses online.

1. What materials are needed for rural medical insurance reimbursement?

The following materials shall be provided for reimbursement of rural medical insurance:

1. Original and photocopy of ID card or household registration book;

2, the new rural cooperative medical insurance card;

3. Original and photocopy of outpatient medical records and discharge summary;

4. Original receipt of medical expenses;

5. Detailed list of expenses;

6. If you entrust others to handle reimbursement, you need to provide the ID card and a copy of the trustee.

First, the scope and proportion of medical insurance reimbursement are as follows:

1, students, children. In a settlement year, medical expenses below RMB 6,543,800+0,800 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 55%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no qifubiaozhun for first-class hospitals, and the reimbursement rate is 65%;

2. Older people over 70 years old. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no qifubiaozhun for first-class hospitals, and the reimbursement rate is 65%;

3. Other urban residents. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%.

Second, the medical insurance reimbursement process:

1. The agent submits the reimbursement documents and other materials to the social security agency for acceptance;

2. After receiving the application materials, the accepting department will complete the examination, settlement and payment on the same day;

3. After the social security agency reviews the materials and approves the application, the applicant receives the reimbursement form of social medical insurance medical expenses and submits it for reimbursement.

In short, the medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Second, how to reimburse the Shanghai Federation of Trade Unions for retirement and mutual medical insurance hospitalization?

Shanghai's serious illness medical insurance and social medical insurance reimbursement are both after discharge or transfer. Settlement procedures for inpatient and outpatient treatment of special diseases:

1. Designated medical institutions should report the expense list, hospitalization list and related materials of patients discharged from hospital last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination;

2 medical insurance agencies pre allocated last month hospitalization and special disease outpatient co-ordination costs;

3. Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly accounted for and settled immediately.

4. Emergency settlement procedure: the medical expenses incurred by the insured in emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall go through the reimbursement procedures according to the provisions with the hospital emergency medical records, inspection, laboratory reports, invoices and detailed list of medical charges.

Legal basis:

People's Republic of China (PRC) Social Insurance Law Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance to protect citizens' right to get material help from the state and society in the event of old age, illness, industrial injury, unemployment and maternity.