Instructions for filing medical treatment in different places for the insured at the same level in Tangshan City

Description of medical record items for the insured at the same level in Tangshan City

I. Scope of personnel

Including retirees resettled in different places, long-term residents in different places, permanent residents in different places and qualified referral and transfer personnel.

Second, the filing method

Medical treatment in different places can be handled through the website of Hebei Medical Insurance Bureau and its official WeChat account, the website of Tangshan Medical Insurance Bureau, the website of Tangshan Human Resources and Social Security Bureau or the smart social security mobile APP, or at the medical insurance agency. After going through the transfer formalities for the first time, you need to take the social security card to the medical insurance agency for card authentication and testing outside the province.

Third, the required materials

You need to hold a social security card and an ID card for handling, and you need to hold a manager's ID card, a doctor's ID card and a social security card for entrusting others.

Fourth, the scope of medical treatment in different places.

In principle, transfer from different places should be transferred to designated medical institutions at or above the second level for medical treatment or specialized courses in different places. Resettlement and referral in different places can be directly filed in the city or province where the doctor is located, Beijing, Tianjin, Shanghai, Chongqing, Hainan, Tibet, Xinjiang Corps, and the province where the doctor is located. The insured shall, in accordance with the principle of hospital transfer, choose the designated medical institutions that have opened direct settlement for medical treatment in different places for hospitalization according to the condition, residence and transportation.

Five, remote referral transfer time limit

After successful referral from different places, it can only be used for medical treatment in different places, and the limitation is one year; Referral and transfer must be re-filed.

Sixth, the standard of medical treatment in different places.

"three types" of personnel)

After filing for medical treatment in different places, you cannot use the social security card to seek medical treatment in the insured place or in the designated medical institutions in different places. The deductible line and payment ratio of special diseases in hospitalization and outpatient service shall be implemented according to the medical treatment standard of our city.

There is no need to re-apply for filing after each hospitalization settlement; After handling medical records in different places, it is generally not allowed to change the place of medical treatment again within half a year. If it is really necessary to change within half a year, the medical expenses incurred in the direct hospitalization of designated medical institutions in different places after the change will be paid in advance by individuals, and will be reimbursed back to the insured place according to the types of referral and transfer personnel in different places, and the outpatient special disease expenses will not be reimbursed; In non-designated medical institutions, in accordance with the relevant provisions of the insurance; After the real estate is changed from a different place to a local place, it can be changed to a different place for more than half a year.

Referral personnel

After the medical treatment in different places is filed, the hospitalization expenses in medical insurance coverage are paid by the individual 10%, and the Qifubiaozhun and reimbursement ratio are implemented according to the hospitalization standards of tertiary medical institutions in our city.

The insured person has gone through the formalities of referral from different places for the record, and discharged from a designated hospital in different places that has signed an agreement on the coordinated development of medical services in Beijing, Tianjin and Hebei, and the payment standard is implemented in accordance with the medical treatment standard of our city.

The specific hospital list is:

Seven, off-site direct settlement policy treatment

The direct settlement of hospitalization medical expenses is based on the policy of "catalogue of medical places, treatment of insured places and management of medical places". Catalogue of medical places: the insured person shall, in principle, implement the payment scope of medical places for medical treatment in different places, including the drug catalogue, diagnosis and treatment items and service facilities standards of basic medical insurance; Treatment of the insured place: The insured person shall, in principle, implement the payment policy of the insured place for medical treatment in different places, including the deductible line, payment ratio and maximum payment limit of the medical insurance fund.

Eight. any other business

The direct settlement and filing of hospitalization in different places is limited to hospitalization in different places caused by the insured's illness, and is not applicable to maternity and accidental injury, and should be borne by a third party.

The insured can log on to the portal of Hebei Medical Insurance Bureau to inquire about designated hospitals in different places and hospitals and pharmacies in different places that have opened inter-provincial networking in the province.

The medical expenses of hospitalization in different places shall be directly settled, and the management of filing before medical treatment shall be implemented. In special circumstances, hospitalization can be carried out first, and re-submission can be made within 10 days.

After handling the direct settlement of medical treatment in different places, if you are hospitalized in a designated medical institution that has opened the direct settlement of medical treatment in different places, you can directly settle the medical expenses with a social security card; If a person is hospitalized in a designated medical institution that has not opened direct settlement for medical treatment in different places, the medical expenses shall be paid in advance by the individual, and the insured place shall apply for reimbursement in accordance with relevant regulations.

If the hospitalization expenses of medical institutions that have achieved direct settlement of medical treatment in different places are not directly settled due to personal reasons, and the hospitalization expenses that have not been registered and filed according to regulations need to be returned to the insured place to apply for reimbursement, it shall be handled according to the relevant provisions of the insured place.

Telephone number for medical consultation in different places: 03 15-5908000.