The medical insurance card is directly settled for medical treatment across provinces and different places.

The National Health Insurance Bureau and the Ministry of Finance jointly issued the Notice on Further Improving the Direct Settlement of Medical Treatment in Different Provinces of Basic Medical Insurance today.

The Notice requires that local medical insurance departments should timely adjust policies and measures inconsistent with this notice to ensure convergence with national policies before the end of 2023 12; Adjust the information system synchronously as required to ensure a smooth transition of direct settlement of medical treatment across provinces and different places. 0030 10 will be officially implemented on June 65438+ 10/day, 2023.

How to directly settle the insured's inter-provincial medical treatment?

The second is to choose points. After the insured person completes the medical record in different places, all inter-provincial networked designated medical institutions opened at the record place can enjoy the inter-provincial direct settlement service of hospitalization expenses; When seeking medical treatment in outpatient department, you need to know the regulations of medical treatment in different places in the insured place first. Where the insured place requires the insured person to choose a certain number or designated level to buy drugs in designated medical institutions networked across provinces, it shall be implemented in accordance with the provisions of the insured place.

The third is to take a coded card to see a doctor. Insured persons shall present valid certificates such as medical insurance electronic certificate or social security card when handling admission registration, discharge settlement and outpatient settlement. Inter-provincial networked designated medical institutions provide reasonable and standardized diagnosis, treatment and direct settlement services for outpatients (emergency) and inpatients who meet the requirements of medical places.

Who can handle medical records in different places?

According to the reasons why the insured of the basic medical insurance seek medical treatment in different places, the procedure of direct settlement of inter-provincial medical treatment in different places divides the people who seek medical treatment in different places into two categories: inter-provincial permanent residents and inter-provincial temporary medical treatment personnel, and further subdivides them into six categories.

Inter-provincial resident population includes retirees resettled in different places, resident population in different places and resident population in different places. Persons who have worked, lived and lived outside the insured province for a long time.

Temporary medical personnel out of the province include referral medical personnel from different places, emergency rescue personnel from different places due to work and business trips, and other temporary medical personnel out of the province.

What is the payment policy of the inter-provincial direct settlement fund for medical treatment in different places?

Inter-provincial direct settlement of hospitalization, general outpatient service and outpatient service for chronic diseases and special diseases shall, in principle, implement the payment scope and relevant regulations (the payment scope of basic medical insurance drugs, medical services and medical consumables) stipulated by the place of medical treatment, and implement relevant policies such as the minimum deductible line, payment ratio, maximum payment limit, outpatient service for chronic diseases and special diseases stipulated by the insured place. Simply put, it is the medical place catalogue and the insurance place policy.

For example, a retired employee in Langfang City, Hebei Province, went to Beijing for medical treatment in a different place on July 1 2023, and directly settled the outpatient expenses for chronic diseases and special diseases. The total cost is 64.29 yuan, and the fund pays 48.89 yuan. This fee consists of two drugs, and the scope of payment according to the list of medical places is as follows: acarbose tablets, one drug, 32.52 yuan, all of which are in line with the scope of fund payment; Class B repaglinide tablets are RMB 365,438+0.77, of which RMB 28.59 is within the scope of fund payment, and Class B is RMB 3.65,438+08 in advance ... According to the payment scope of the medical treatment place, the total expenses within the scope of basic medical insurance fund payment are 611(32 According to the proportion of doctors' insured places, the fund pays 48.89 yuan (61.1* 80%).

After a long-term cross-provincial life record,

Can medical insurance be reused after returning to the original insured place?

In order to meet the actual needs of long-term residents across provinces to return to their insured places for medical treatment and reimbursement, the Notice clearly stipulates that long-term residents across provinces are allowed.

Related Questions and Answers: Legal Analysis on How to Reimburse Medical Insurance in Different Places: 1. According to the medical insurance policy for urban residents, the insured must first register with the medical insurance agency in the insured area. (Emergency patients who need to go to the hospital in time for treatment in the field should call the medical insurance agency in the insured place for filing within 3 days after hospitalization). Among them, the medical expenses paid by the insured person must be paid in full by the individual first.

2. After discharge 1 month, the insured person can go through the medical expense reimbursement procedures at the medical insurance agency where the household registration is located with ID card, residence booklet, residents' medical insurance card, discharge certificate, medical expense invoice, detailed list of hospitalization expenses, proof of living in different places or temporary residence permit.

3. Medical personnel must report to the medical insurance center of the insured place for the record when they are hospitalized. If the insured fails to go through the filing formalities according to the regulations, the medical insurance institution will not reimburse the medical expenses incurred in hospitalization.

When reimbursing in different places, you must first register with the medical insurance agency in the insured place, and the medical expenses incurred shall be paid in advance by the individual. Some proof materials to be reimbursed after discharge shall be reimbursed by the medical insurance agency where the insured person's household registration is located.

Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid from the basic medical insurance fund in accordance with state regulations.

Warm reminder that the above answer is only for the current information combined with my understanding of the law. Please refer carefully! If you still have questions about this issue, I suggest you sort out relevant information and communicate with professionals in detail.