Guangzhou social security temporary medical treatment in different places

Instructions for medical treatment in different places

(Applicable to the insured of basic medical insurance for urban workers)

1. Who can apply for long-term medical treatment in different places?

The following insured persons who participate in the basic medical insurance for urban workers in our city in the form of employers may apply for long-term medical treatment in different places:

1. The retirees have lived in the same place in China for more than half a year;

2. The employees of the employer are insured persons who have worked in different places in China for more than half a year.

Second, how to apply for long-term medical treatment in different places?

(1) The manager of the insured unit holds the unit certificate, or the applicant applies for the Guangzhou Social Medical Insurance Record Book for Medical Treatment in Different Places (hereinafter referred to as the Record Book for Medical Treatment in Different Places) with the medical insurance card. (If it is necessary to reissue or replace the medical record book in different places due to loss or damage for the first time, it shall be purchased according to the charging standard approved by the price department).

(II) The insured unit or the insured person shall select 1 ~ 3 designated medical institutions for basic medical insurance in the same place of residence according to regulations (public medical institutions at or above the town level shall be selected if basic medical insurance is not implemented locally), and the selected medical institutions (the level of medical institutions shall be indicated) and local social (medical) insurance agencies shall check and seal the medical record book in different places, and carry the following information to the secondary medical insurance agencies in this Municipality for confirmation.

Information to be carried in handling medical treatment procedures in different places

serial number

Personnel category

Transfer information

Handling place

Carrying special materials (corresponding categories)

Basic information and related procedures

1.

On-the-job personnel of this unit

(1) Certificate of Medical Treatment in Different Places of Work Unit

(2) The business license (photocopy) of the branch in different places or relevant certification materials issued by government departments for overseas institutions.

Labor contract between the insured unit and the insured (valid for more than half a year)

(1) Recent one-inch bareheaded color photos.

② Guangzhou social medical insurance medical record book in different places.

Guangzhou medical insurance Ji' er handling organization

2.

retiree

(1) The residence certificate for medical treatment in different places or the copy of the temporary residence certificate or temporary residence permit for more than half a year issued by the local police station (street, neighborhood committee and village committee) or the copy of the household registration book in different places that is the same as the application for medical treatment in different places.

② unit certificate

3.

Labor dispatch agencies in this municipality

① Relevant labor dispatch agreement between the labor dispatch agency and the dispatched agency (copy)

② Business license of the dispatched office operating in Guangzhou (copy)

(3) The relevant business license (photocopy) of the branch where the insured declares medical treatment in different places.

(4) Labor contract between the labor dispatch agency and the insured (valid for more than two years)

(5) the certificate of factual labor relationship with the insured issued by the agency.

⑥ Certificate of Work Unit for Medical Treatment in Different Places

All landowners professional intermediary business license (copy) and other relevant certificates.

four

Professional intermediaries in this city

(1) Certificate of Medical Treatment in Different Places of Work Unit

(2) Business license of branch in different places (copy)

Labor contract between the insured unit and the insured (valid for more than half a year)

(4) Business license (photocopy) and other relevant certificates of professional intermediary institutions.

Note: Units applying for medical treatment in different places need to provide the electronic batch import form for medical treatment in different places, which can be downloaded from Guangzhou Medical Insurance Network or obtained from the service window of the municipal secondary medical insurance agency.

3. When applying for medical treatment in different places for the first time, there are less than three designated medical institutions. How to supplement them?

If there are less than 3 designated medical institutions selected in the initial bid for medical treatment in different places, and it is necessary to supplement 1 or 2 designated medical institutions, it shall be handled according to the provisions and requirements of the initial bid for medical treatment in different places (see question 2 for details), and the original record book of medical treatment in different places for the original bid procedures shall be attached.

4. Under what circumstances can the medical institution selected for medical treatment in different places be changed? How to go through the change procedures?

(a) designated medical institutions in different places have been selected, and the selected medical institutions shall not be changed in the second half of the year. In any of the following circumstances, you can go through the relevant change procedures:

1. Due to the need of disease treatment

After applying for and approving medical treatment in different places for half a year, it can be handled according to the provisions and requirements of the first application for medical treatment in different places (see question 2 for details); Less than half a year, if the hospital needs to be changed due to illness, it is necessary to attach the relevant medical record materials issued by the replacement medical institution and the original "medical record book in different places" to handle the original application procedures.

Move to a new place of residence

After applying for and approving the procedures for medical treatment in different places for half a year, you can go to the municipal medical insurance agency to go through the change procedures according to the provisions and requirements of the first medical treatment in different places (see question 2 for details), and attach the certificate of new residence in different places or the copy of the certificate or temporary residence permit issued by the local police station (street, neighborhood Committee, village Committee) who has lived for more than half a year, and the original record book of medical treatment in different places for the original application procedures.

(2) The name change or grade change of the medical institution.

With the original and photocopy of the valid change certificate issued by the original selected medical institution and the original of the "Record Book of Medical Treatment in Different Places" for the original application procedures, go through the change procedures at the secondary medical insurance agency of the city.

(three) the personal data or the name of the insured unit has changed.

According to the regulations and requirements for the initial application for medical treatment in different places (see question 2 for details), the original of the Record Book of Medical Treatment in Different Places issued by the social security institution to which the insured belongs shall go through the change formalities at the secondary agency of municipal medical insurance.

5. How to enjoy medical insurance benefits after long-term medical treatment in different places?

After the insured person goes through the confirmation procedures for medical treatment in different places, the following medical expenses incurred by the selected medical institutions in different places confirmed by the municipal secondary medical insurance agency shall be paid in advance by the individual and applied for sporadic reimbursement to the municipal secondary medical insurance agency:

Medical expenses for hospitalization and emergency observation;

(II) Medical expenses incurred in the examination and approval of the municipal medical insurance secondary agency and the corresponding outpatient specific items (radiotherapy and chemotherapy for malignant tumors, anti-rejection treatment after liver and kidney transplantation, uremia hemodialysis and peritoneal dialysis) and the treatment of chronic diseases in designated outpatient clinics within the validity period of examination and approval.

Six, the insured who has gone through medical treatment in different places can enjoy medical insurance benefits when they return to the designated medical institutions in the medical insurance co-ordination area of Guangzhou?

Of course. After being paid in cash by individuals, within 1 month from the date of discharge (or settlement of medical expenses), according to the relevant provisions of the audit and reimbursement management of sporadic medical expenses in Guangzhou basic medical insurance, apply to the secondary medical insurance agency of the city for reimbursement of related medical expenses paid by the overall fund.

7. What are the conditions and procedures for canceling medical treatment in different places?

Insured persons who have applied for medical treatment in different places can apply for cancellation of medical treatment in different places when they return to Guangzhou medical insurance co-ordination area to live and work for a long time. You can't apply for medical treatment in different places again within six months after cancellation.

The insured, upon his own application, goes through the cancellation procedures of medical treatment in different places with the original Record Book of Medical Treatment in Different Places; After handling, the basic medical expenses paid by the insured person from the overall fund can be directly recorded in the designated medical institutions.

Eight, suspend or terminate the insured and change the insured unit, how to deal with the original application for medical treatment in different places?

For the insured who have gone through the examination and approval procedures for medical treatment in different places, if the insured suspends (on-the-job), terminates (on-the-job/retired) or changes the insured unit (on-the-job), the original examination and approval for medical treatment in different places will be invalid; If the insured unit (retired) changes and fails to go through the examination and approval procedures for the change of medical treatment in different places in time, the original examination and approval for medical treatment in different places will be invalid. In the above situation, the medical insurance fund for medical expenses in different places will no longer pay.

Note: The documents provided by the remote medical certificate, remote medical certificate and remote electronic medical batch import form can be downloaded from Guangzhou Medical Insurance Network or obtained from the service window of the municipal secondary medical insurance agency. (Website:).

Medical services don't need to go to the municipal medical insurance center on Mei Dong Road, as long as they are handled by secondary agencies in nearby districts.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.