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Guang 'an Wusheng County Social Security Card
There is no clear legal definition of medical treatment in different places. In social medical insurance coverage, "off-site" generally refers to other areas in China outside the insured's overall planning area, and "seeking medical treatment" refers to the insured's medical treatment behavior, which can be simply defined as the insured's medical treatment behavior outside its overall planning area.
"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) to travel, study and visit 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.
Social insurance law
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.
Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.
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