Medical insurance reimbursement process for not seeking medical treatment in the insured place

Legal analysis: 1, long-term residence in different places for medical treatment

(1) The insured person who has gone through the filing and registration shall fill in the registration form of medical treatment in different places for basic medical insurance according to the provisions of medical insurance, and provide his ID card, social security card and proof of long-term residence in different places. Log in to Social Security official website for online declaration.

Fill in the filing information and go to the local social security bureau to fill in the offline filing registration form.

(2) Be sure to choose a designated hospital for filing, because patients can only get medical insurance reimbursement in different places if they go to a designated hospital for filing and registration. If you don't know which hospitals can settle accounts in different places, you can log on to the social security network to inquire.

(3) As long as the insured who holds the card for medical treatment completes the registration, goes to the designated hospital for medical treatment, and then brings the social security card, he can directly register for admission and settle the medical expenses without paying in advance. So you must remember to bring your own medical insurance card when you see a doctor.

2. Referral for medical treatment in different places Referral for medical treatment in different places requires the local hospital to issue a "Referral and Transfer Certificate" to go through the formalities of medical treatment in different places. It should be noted that it is more important to find a hospital to issue a "referral and transfer certificate", and "referral and transfer" should also meet the three conditions of "step-by-step treatment, expert review and two-way referral". Simply put, local hospitals are unable to treat hospitals referred by local top three hospitals, and the treatment level is higher.

3. Going out for temporary medical treatment in different places If it is a temporary emergency, hospitals in many cities now support "treatment first, then reimbursement", but the proportion of reimbursement will be reduced. If it is an ordinary outpatient clinic, the cost is relatively low, you can keep the bill and return it to the insured place, and then submit the information for reimbursement. If the cost of treatment is relatively high, you can first register with the social security filing bureau of the insured place (telephone filing is supported), and then reimburse according to the standard of referral certificate after the disease is cured (treatment fee is paid in advance).

It is not easy to seek medical reimbursement in different places. Friends who need medical treatment in different places must know the relevant matters in advance before seeing a doctor. It should be noted that the premise of medical insurance reimbursement in different places is that medical insurance expenses have been paid and they are in a normal state of participation. Failing to pay the medical insurance fee on time, you can't use the medical insurance reimbursement function in different places.

Legal basis: Article 13 of the Social Insurance Law of People's Republic of China (PRC), employees shall participate in the basic medical insurance for employees, and the employer and employees shall jointly pay the basic medical insurance premium according to state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.