The latest notice is here!Direct settlement of medical insurance across provinces

Author:Tibet Time:2022.07.26

Source: CCTV News

The State Medical Insurance Bureau jointly issued the "Notice on Further Direct Settlement of Basic Medical Insurance Cross -Provincial Different Places" with the Ministry of Finance today.

The "Notice" requires that local medical insurance departments must adjust policies and measures that do not match this notice in a timely manner to ensure connection with national policies by the end of December 2022; adjust the information system simultaneously according to requirements to ensure a stable transition from direct settlement of cross -province medical treatment. The "Basic Medical Insurance Cross -Provincial Different Places Direct Settlement Regulations" will be officially implemented from January 1, 2023.

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How can insured persons settle directly across provinces?

The first is to record first. Before the insured person across provinces, you can go through online and offline channels such as the national medical insurance service platform APP, the national medical treatment filing applet, the client applet of the State Council, or the window of the insured place.

The second is the selection point. After the insured personally completes the medical treatment for a different place, all the cross -provincial fixed -point medical institutions that have been opened in the filing place can enjoy the direct settlement service of the hospitalization expenses across the province; If the insured person is required to choose a certain number or to buy medicines for medical institutions at a designated level of inter -provincial networking, it shall be implemented in accordance with the provisions of the participating place.

The third is to seek medical treatment. Insured personnel need to be reported to the hospital for registration, discharge settlement, and outpatient settlement. They need to be obtained from effective vouchers such as medical insurance electronic vouchers or social security cards. The inter -provincial network of designated pharmaceutical institutions provides a reasonable, standardized diagnosis and treatment and direct settlement services for medical treatment and inpatient patients in accordance with the regulations of the medical site.

Who can apply for medical treatment in a different place?

According to the reasons of basic medical insurance insured persons, the "notice" divided the medical record personnel in different places into two types of categories: long -term residents of inter -provincial and different places, and temporary temporary inter -provincial medical personnel, and further subdivided into 6 kinds of personnel.

Long -term residents of cross -provinces include remote resettlement retirees, long -term residents in different places, and residents who resident residents who have worked, residents, and living outside the province for a long time.

Cross -provincial temporary medical personnel include referral personnel in different places, and due to work, tourism and other reasons for different places emergency rescue personnel and other inter -provincial temporary medical treatment personnel.

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What is the payment policy for direct settlement funds in the province?

Cross -provincial medical expenses directly settled in hospitals, general outpatient and outpatient medical expenses, in principle implement the scope of payment specified in the medical place and relevant regulations (basic medical insurance drugs, medical service items, medical consumables and other payment scope), implement participation participation) The relevant policies such as starting standards, payment ratios, maximum payment limit, and outpatient slow disease scope of basic medical insurance funds stipulated in the preservation ground are. Simply put, it is the policy of medical treatment and the place where the insurance is participating in the place of insurance.

For example: a retired employee in Langfang City, Hebei Province, directly settled the outpatient medical expenses directly in Beijing's cross -province for medical treatment on July 1, 2022. The total cost is 64.29 yuan, and the fund pays 48.89 yuan. There are two medicines for this pen. According to the payment scope of the medical area directory: 32.52 yuan of Akaba sugar tablets of category A drug, all in line with the fund payment scope; The scope of payment, 3.18 yuan is to pay for it first. According to the scope of the payment of medical treatment, the total cost of the basic medical insurance fund is 61.11 (32.52+28.59), the category B payment amount is 3.18 yuan. )Yuan.

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After the long -term residents of inter -provincial residents will be recorded,

Can I still use the medical insurance of the original conservation site?

In order to meet the actual needs of the long -term residents of cross -provincial long -term residents to return to the medical treatment due to reasons such as visiting relatives, the "Notice" clearly stipulates that long -term residents of cross -provinces can enjoy the treatment in both directions and the place of insurance.

During the validity period of long -term residents for long -term residents in different provinces, those who need to return to the insurance place for medical insurance can enjoy medical insurance settlement services in the place of insurance, and in principle, it is not lower than the level of treatment of inter -provincial referral transfer.

If you suddenly go out, you need to see the emergency department,

What should I do if they are too late to record?

The "Notice" stipulates that the expenses of emergency rescue are included in the scope of direct settlement of cross -provincial medical treatment, and emergency personnel in different places are regarded as filing and no additional filing materials are required.

Considering the actual situation of emergency rescue patients, the medical insurance agency will determine whether it is an emergency rescue patient in accordance with the emergency logo of the designated network of medical institutions. Rescue patients to seek medical treatment.