Kaifeng medical insurance filing policy in different places

According to the spirit of documents such as the Notice of the National Medical Insurance Bureau and the Ministry of Finance on Further Improving the Direct Settlement of Basic Medical Insurance in Different Provinces and the Notice of the Henan Provincial Department of Finance on Further Improving the Direct Settlement of Basic Medical Insurance in Different Places,

On February 22nd, 2022, 65438+, Kaifeng Medical Insurance Bureau and Kaifeng Finance Bureau jointly signed the following agreement.

It is decided to adjust the relevant policies on direct settlement of medical insurance in different places from 2023 1.

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The first is to rationally adjust the reimbursement policy for temporary medical personnel.

The payment ratio of off-site referral personnel and off-site emergency rescue personnel is reduced by 10 percentage point on the basis of the reimbursement level of medical institutions at the same level in the insured area.

Non-emergency, non-referral of other temporary outpatient medical staff, the proportion of payment in the insured medical institutions at the same level based on the reimbursement level decreased by 20 percentage points.

The second is to support long-term residents in different places to enjoy direct medical insurance settlement services at both the filing place and the insured place.

When long-term residents in different places go to the record place for medical treatment and settlement, the minimum payment standard, payment ratio and maximum payment limit of the basic medical insurance fund shall implement the local medical treatment standard stipulated by the insured place.

If it is really necessary to go back to the insured place for medical treatment within the validity period of filing, you can enjoy the direct settlement service of medical insurance in the insured place, and the payment ratio will be reduced by 10 percentage point on the basis of the reimbursement level of medical institutions at the same level in the insured place.

Long-term residents in different places who meet the conditions of medical treatment in different places shall implement the policy of referral and transfer to the insured place.

The third is to allow the insured who re-submit medical records in different places to enjoy the direct settlement service for medical treatment in different places.

join

security personnel

Re-submit for medical treatment in different places before discharge settlement.

, medical networking designated medical machine.

Constructive response

Direct settlement of medical expenses for the insured.

Insured persons who seek medical treatment in different places are discharged at their own expense.

Make up according to regulations after settlement.

For reporting procedures, you can

According to the provisions of the insured area.

Medical insurance handbook

compensation

The fourth is to standardize the validity period of medical records in different places.

According to the scope of the application for medical registration and filing in different places, a reasonable filing validity period should be set uniformly.

For long-term residents in different places, the implementation of "one record, long-term effective".

After registration, the insured does not apply for changing the filing information or the insured status has not changed, and the filing is valid for a long time. In principle, it is not allowed to apply for change within 6 months after the filing takes effect (the time limit is currently 12 months).

For those who go out for medical treatment temporarily, the implementation of "a record, effective for half a year".

Within the validity period of 6 months, you can see a doctor many times and enjoy the direct settlement service (the current time limit is 12 months). If you go through the admission formalities within the validity period of the record and are discharged after the expiration of the validity period, the extended time shall be deemed to be within the validity period of the record.