Dongguan social security hospitalization reimbursement process

The social security department shall, in accordance with the principle of territoriality, designate a designated social insurance community health service institution as the outpatient service point of the insured person within the jurisdiction of the village (neighborhood committee); If there are no designated community health service institutions in China, the adjacent designated community health service institutions shall be designated as temporary designated outpatient service points. If the residence of the insured registered in this Municipality and the designated outpatient medical point are not in the same village (neighborhood) committee, the insured can apply for change to the designated community health service center of this town (street), and after approval, the outpatient medical point can be changed to the designated outpatient medical point of the same town (street) residence. Changes in the employer, the insured person's work unit, the insured person's household registration or residence in this city, etc. , the insured person's outpatient medical point can be changed according to the regulations, and the change will take effect the next month. Tips: From June 65438+1 October1day, the medical security of community outpatient service of social basic medical insurance in Dongguan was officially implemented. The insured person shall go through the formalities of medical treatment and reimbursement according to relevant regulations. Outpatient medical security, to ensure the basic outpatient medical care of the insured, the implementation of designated outpatient medical points designated medical care. In order to protect the medical rights and interests of the insured, please be sure to seek medical treatment according to the regulations. The insured person goes to the designated outpatient clinic for medical treatment and reimburses the medical expenses. If the insured person goes to the designated outpatient clinic for medical treatment due to illness, he can go through the reimbursement procedures at the scene after seeing the doctor, without going to the social security department for reimbursement. 1. How to register for outpatient service? The insured person holds his social security card and ID card (ID card for those who have not issued social security card, and his social security card for those below 18) to go through the registration formalities at the designated outpatient registration office. 2. Does the use of self-funded items have to be confirmed by the insured? When the attending doctor provides outpatient service for the insured, it must be confirmed by the insured or his family members when he needs to use drugs, materials and inspection and treatment items at his own expense or part of his own expense for the insured due to illness. 3. How to handle the reimbursement procedures for outpatient medical expenses? The insured holds his social security card, ID card, outpatient prescription, etc. Go through the reimbursement procedures at the designated outpatient medical point charge office. 4. What are the rules for reimbursement of outpatient medical expenses? The medical expenses incurred by the insured in the outpatient clinic according to the regulations shall be handled according to the following provisions: ① Use the drugs within the outpatient scope of the community health service of the social basic medical insurance in our city (hereinafter referred to as the outpatient scope), and strictly control the dosage. Outpatient acute diseases generally do not exceed three days, chronic diseases generally do not exceed seven days, and specific outpatient services generally do not exceed one month, of which intravenous medication does not exceed one day; (2) If medical treatment items or medical materials are used in the Scope of Medical Service Facilities and Payment Scope of Dongguan Employees' Basic Medical Insurance (hereinafter referred to as the scope of medical treatment items and medical service facilities), the part of the single cost within 120 yuan (including 120 yuan, the same below) shall be paid by the overall fund according to regulations; (3) the use of Chinese herbal medicine prescription, each dose 10 yuan, each prescription within 3 doses of basic medical expenses, according to the provisions of the overall fund to pay; (4) The expenses incurred by drugs and medical treatment projects beyond the above-mentioned provisions or using community clinics, medical treatment projects and medical service facilities shall be paid by the insured.

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