How to handle medical insurance for serious illness in different places?

According to the local medical insurance regulations, people who go to see a doctor in different places must first go through the registration procedures for medical treatment in different places, and the medical expenses incurred in different places must be paid in advance by themselves. After the medical treatment, you should go through the reimbursement procedures with the relevant bills to the medical insurance agency in the insured area. If the medical insurance network settlement is realized between the insured place and the medical treatment place, the personnel who need medical treatment in different places can go through the medical treatment procedures in different places in accordance with the relevant provisions of local medical insurance, and then swipe the medical insurance card at the medical treatment place in different places to directly settle the medical expenses without paying the medical expenses in advance. A cooperative relationship of medical insurance reimbursement has been established between the insured place and the medical place where the insured person wants to go, so that the insured person can directly entrust the medical insurance agency of the medical place to handle the medical expenses reimbursement in the medical place after going through the relevant registration and filing procedures in the medical insurance agency of the insured place according to regulations.

Medical insurance reimbursement categories and supporting materials:

1. Transfer for medical treatment: If it is really necessary to transfer for medical treatment, if the condition is urgent, the formalities should be completed within 7 days of transfer and admission;

2. Resettlement and work in different places: if you want to live and work in different places for more than half a year, you must go through the registration formalities in advance;

3. Medical expenses during short-term outings such as business trip, visiting relatives and traveling: ① Acute illness: providing business trip certificate, visiting relatives certificate, travel contract, air ticket to real-name registration system, etc. At the time of reimbursement; (2) outpatient maintenance treatment of chronic diseases: the medical records of Xiamen should be increased, and the measures of diagnosis and treatment should not exceed that of Xiamen;

4. Off-site delivery: hospitalization delivery expenses and reasonable prenatal and postpartum examination expenses;

5. Failures of social security system in local and urbanized areas cannot be settled in real time by credit cards: the invoices of the charging offices of medical institutions should be endorsed and stamped;

6. The social security card is reported lost or damaged, and the printing of the business card is delayed: the back of the invoice of the social security card management department is stamped for confirmation;

7. The number of outpatient visits in a single month exceeds 20: the bill must be settled by credit card and show the number of registered visits, and outpatient records must be provided;

8. Acute illness or rescue without social security card: the medical records of outpatient or inpatient should be detailed and clear enough to be identified as acute illness or rescue;

9. Off-catalogue drug expenses of retired cadres: An Approval Form for Off-catalogue Drugs of Retired Cadres should be provided and stamped with the official seal of the hospital medical insurance management department; The retired cadres entrusted by the provincial two-level charging center should provide health care certificates;

10. Enrolment status, change, change of insured unit and delay in receiving local tax data: reimbursement can be made after the local tax change is confirmed in the middle of the next month;

1 1. Medical expenses of newborns from birth: they should be insured within three months of birth and paid in time, and can only be reimbursed after receiving the money. Need a birth certificate; For the unnamed newborn at the time of expense, the name on reimbursement vouchers such as medical expense invoices, summary tables and discharge records should be the name of the mother or father followed by "son" or "daughter".

To sum up, 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. Hospitalization procedures for retired people in different places.

Legal basis:

"Detailed Rules for the Implementation of People's Republic of China (PRC) Social Insurance Law" Article 8.

The medical expenses incurred by the insured in the agreed medical institutions that meet the basic medical insurance drug list, diagnosis and treatment items and medical service facilities standards shall be paid from the basic medical insurance fund in accordance with state regulations. If the insured really needs emergency treatment and rescue, he can seek medical treatment in a non-agreement medical institution; The scope of drugs that must be used for rescue can be appropriately relaxed. The specific measures for the administration of emergency and rescue medical services of the insured shall be formulated by the overall planning area according to the local actual situation.