How does Jinan Medical Insurance Network check whether the on-site medical examination certificate has passed the audit?

How to check the medical certificate online: Open the browser, log in to official website of Jinan Human Resources and Social Security Bureau (website: jn hrss. Jian. gov. cn/), click on "Online Service Hall"-"Social Insurance"-"Social Insurance Inquiry" at the bottom of the webpage, and then choose the appropriate way to log in, and you will find it.

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Introduction to the Policy of Prescribed Diseases in Outpatient Department of Jinan Residents' Basic Medical Insurance

First, the outpatient disease refers to the diseases recognized by the municipal social insurance administrative department, treated in designated medical institutions, and paid by the residents' basic medical insurance fund according to the prescribed proportion, including:

(1) to treat malignant tumor and leukemia;

(2) Dialysis treatment of renal failure;

(3) Anti-rejection therapy of organ transplantation;

(4) hemophilia;

(5) Aplastic anemia;

(6) Systemic lupus erythematosus;

(7) Parkinson's disease and syndrome;

(8) Mental illness

(9) Phenylketonuria

Among them, the application scope of hemophilia and aplastic anemia is extended from college students, children and other residents below 18 to all insured residents; Parkinson's disease and syndrome are only applicable to adult residents.

Second, the insured person in a medical year in line with the basic medical insurance fund for residents to pay the scope of outpatient medical expenses (including individuals according to a certain proportion of the burden), the implementation of Qifubiaozhun and the highest payment limit. Medical expenses below Qifubiaozhun and above the maximum payment limit shall be borne by individuals.

The outpatient service stipulates that the disease Qifubiaozhun is 200 yuan, and the insured person only undertakes it once in a medical year. The maximum compensation limit is 200,000 yuan.

Three, the insured in a medical year in accordance with the provisions of the basic medical insurance fund to pay the scope of outpatient medical expenses, paid by the basic medical insurance fund and individuals in accordance with the following standards:

(1) If college students are treated in tertiary medical institutions, 60% will be paid by residents' basic medical insurance fund and 40% will be borne by individuals; For medical treatment in secondary medical institutions, 70% is paid by the residents' basic medical insurance fund, and 30% is borne by individuals; In the first-class medical institutions, township hospitals for medical treatment, the basic medical insurance fund for residents to pay 80%, personal burden of 20%.

(2) Insured persons (excluding college students) do not distinguish between individual payment grades. For medical treatment in secondary medical institutions, the proportion of fund payment is 65%; In the first-class medical institutions, the proportion of fund payment is 75%; For medical treatment in medical institutions that fully implement the national essential drug system, the fund payment ratio is 90%.

For outpatient dialysis treatment of renal failure, the proportion of residents' basic medical insurance fund payment is 80% (township hospitals are still 90%), regardless of the level of payment and the level of medical institutions.

Four, into the outpatient disease management of the insured, can choose a designated medical institutions (excluding village clinics) for medical treatment, the selected designated medical institutions shall not be changed within a medical year. If it is necessary to change the designated point in the next medical year, it shall go through the change formalities at the newly selected designated medical institution two months before the start of each medical year. Outpatients with prescribed diseases should show their medical insurance cards and door-to-door regulations at the same time when seeking medical treatment.

The residents' basic medical insurance fund does not pay the referral fee of the outpatient insured.