How to handle the process of Jinan door rules

Legal analysis: 1. Insured's application:

The insured shall apply to the corresponding reporting unit for outpatient disease identification and provide relevant materials.

2, the provisions of the unit for the insured to declare the door:

The applicant chooses one of the following two ways to declare the door rules for the insured.

(1) Online application: The unit that handles business through the online application system of the Social Security Bureau can log in to the online application system of the Social Security Bureau, enter the applicant's information, select the declared diseases and designated hospitals, and then submit the application, waiting for the approval of the Municipal Social Security Bureau.

Online declaration of "malignant tumor treatment", "uremia dialysis", "organ transplant anti-rejection" and other major diseases in-service insured, according to the requirements of Article 1 (4), the materials will be sent to the social security bureau to declare the window for review.

(II) On-site declaration: For the unit that cannot make online declaration, the handling personnel shall make a preliminary examination of the relevant materials submitted by the applicant, fill in the Confirmation Form for the Application of Prescribed Diseases in the Outpatient Department of Basic Medical Insurance for Employees in Jinan City in duplicate and sign it by myself, and affix the official seal after the handling personnel check it correctly. Handling personnel fill in the "roster of applicants for diseases specified in the outpatient service of medical insurance for employees in Jinan City" and affix their official seals, and submit it together with the special electronic offer form to the door regulation declaration window of the Municipal Social Security Bureau.

On-the-job insured persons who declare off-site ID numbers of major diseases such as malignant tumor treatment, dialysis treatment of chronic renal failure (uremia stage) and organ transplantation anti-rejection shall send the materials to the social security bureau for review according to the requirements of Item (4) of Article 1.

In order to ensure that the insured who apply for the treatment of malignant tumor, dialysis treatment of chronic renal failure (uremia), anti-rejection treatment of organ transplant patients and mental illness can enjoy the treatment of door rules in time, each reporting unit can declare the applicants of the above four diseases separately (that is, the rest 19 outpatient diseases are not declared at the same time), and the Municipal Social Security Bureau will give priority to physical examination.

Every Friday, due to the need to check the list of medical examiners for next week, the application for prescribed diseases in outpatient service will not be accepted for the time being.

3. issue a medical examination notice.

(a) online reporting units, after the audit of the Municipal Social Security Bureau, printed in duplicate by the handling personnel and signed by myself, and stamped with the official seal after checking by the handling personnel. There are feedback mechanisms and time in the table.

(II) The unit reporting on the spot shall, with the approval of the Municipal Social Security Bureau's Door Regulation Department, arrange the door regulation disease physical examination and appraisal institution and time, and issue a medical examination notice, and the handling personnel shall inform the applicant of the contents of the medical examination notice in time. If the applicant fails to pass the acceptance examination, the applicant shall be informed of the reasons and the original materials submitted shall be returned.

The physical examination and appraisal institution for on-site diseases is determined according to the applicant's location, among which: the location is tianqiao district and Huaiyin District, and the physical examination hospital is jinan military area command 456 Hospital; The locations are Shizhong District and Changqing District, and the physical examination hospital is the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine. The locations are Lixia District, Licheng District and High-tech Zone, and the physical examination hospital is Shandong Armed Police Corps Hospital.

4. The applicant shall register for medical examination. Applicants should register for physical examination at the designated on-site disease physical examination and appraisal institution according to the prescribed physical examination time, and bring the following materials:

(a) my social security card or identity card;

(2) A confirmation form for on-site disease application in duplicate;

(three) medical records related to the disease application (copy of inpatient medical records, original outpatient medical records) and inspection reports.

If the medical records provided by the applicant are incomplete and need further examination and confirmation, the examination items shall be charged by the on-site disease identification institution according to the standards approved by the price department and the health department. The insured can pay the related expenses with cash or personal account of social security card.

5. Issue appraisal opinions. The expert committee of door gauge appraisal regularly examines and appraises the applicant's application materials, and puts forward appraisal opinions, which shall be confirmed by the expert group of the Municipal Social Security Bureau.

6. Publish the evaluation results. The Municipal Social Security Bureau shall check the appraisal information data, record and print the "Physical Examination Certificate of Door Rules" after confirmation. The list of people who have passed the appraisal is published on the website of Jinan Social Security Bureau.

7. Get the medical records. After the website of the Municipal Social Security Bureau issued the license notice, the handling personnel brought their ID cards and letters of introduction to the medical examination and appraisal institutions of various diseases to receive the medical records of the applicant last month, and the latter was responsible for issuing the return certificates of medical records of various diseases and diseases.

To apply for medical records of malignant tumor treatment, dialysis treatment of chronic renal failure (uremia), anti-rejection treatment of organ transplant patients and mental illness, the handling personnel can directly go to the door-to-door registration window of the Municipal Social Security Bureau to receive them.

8. Permit and affix the disease seal. The applicant holds the "Certificate of Return of Medical Records of Door-gauge Disease Identification" and the applicant's one-inch color photo (the original certificate of door-gauge is brought by the person with increased illness), and receives the medical certificate of door-gauge at the door-gauge permission window of the Municipal Social Security Bureau (the person with increased illness is stamped with the disease seal), and is responsible for returning the relevant medical records of the applicant to me.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Article 3 The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.