How to settle in medical insurance across provinces?Who can apply?The country is unified

On July 26, the State Medical Insurance Bureau and the Ministry of Finance issued the "Notice on Further Doing a Basic Medical Insurance Cross -Provincial Different Place Different Settlement Work" to deepen the direct settlement reform of cross -provincial medical treatment, cracked the incomplete medical records of different places, etc. Difficulty.

Promoting the direct settlement of cross -provincial medical treatment costs is an important reform measure to improve the medical insurance system and solve the outstanding concerns of the people.

The notice clearly clearly settled the "Fourteenth Five -Year Plan" target task of direct settlement of inter -provincial and different places. Before the end of 2025, the direct settlement system system and management service system of cross -provincial medical treatment systems are more sound. Different places have a significant improvement in medical settlement capacity, and the direct settlement rate of hospitalization expenses across provinces increases to more than 70%.

The notice uniformly uniformly set up direct settlement such as hospitalization, ordinary outpatient and outpatient slow special diseases, and clearly implemented the "medical land catalog and place to participate in the insurance" fund payment policy in principle during cross -provincial direct settlement; Fixed -point and code cards to seek medical treatment services for different places; "prepaid, then liquidation" for medical management requirements for medical treatment funds.

The notice further regulates the filing policy of different places, including the scope of the personnel of the medical treatment records to the inter -provincial emergency personnel and non -emergency consultation personnel; uniformly filing validity period, the insured during the validity period can be visited many times and enjoy the direct settlement service at the medical place multiple times and enjoy the direct settlement service ; Support participants to enjoy treatment in both directions in the record place and the place of insurance.

In addition, the scope of direct settlement services for fixed -point medical institutions is notified, and the expenses of emergency rescue costs, out -of -hospital examinations during hospitalization, and non -third -party trauma costs that meet the regulations of medical ground management are included in the direct settlement scope of cross -provincial medical treatment. Insured participants are allowed to apply for medical treatment before discharged and settled, and enjoy cross -provincial direct settlement services.

In terms of coordinated business, notifying the cross -regional collaborative process of the agencies, the establishment of a mechanism for collaborative treatment of medical sites and participating places, and improving the efficiency of collaborative disposal of regional issues.

The notice requires that the medical insurance departments in various places should adjust relevant policies and measures in a timely manner to ensure that they will be connected with national policies by the end of December 2022. Relevant policies will be officially implemented from January 1, 2023.

Who can apply for medical treatment across provinces? How to settle? New rules are answered

The five major goals to promote medical treatment are more convenient

Question: What is the progress of direct settlement work for cross -provinces and different places, and what is the work goal of the end of the fourteenth and fifteenth and fifteenth and fifteen -five?

Answer: Since last year, on the basis of fully realizing the direct settlement of hospitalization expenses across provinces, all coordinated areas have achieved general outpatient expenses cross -provincial direct settlement and different regions in different places. Five outpatient treatment expenses such as chemotherapy, uremia dialysis, and organ transplantation of malignant tumor outpatient clinics are directly settled in the province. As of the end of June 2022, there were 246,700 fixed -point pharmaceutical institutions across the country. Basically, at least one designated medical institution in each county could directly reimburse the target of medical expenses including outpatient costs. Fund pays 201976 billion yuan.

According to the requirements of the "Notice", by the end of 2025, the direct settlement system system and management service system of cross -provincial medical treatment will be more sound. The supporting role of a unified medical insurance information platform in the country will continue to strengthen, and the national medical treatment capacity will be significantly improved.

Specifically, the first is that the direct settlement rate of hospitalization expenses is increased to more than 70%; the second is that the number of ordinary outpatient cross -provincial networking -point pharmaceutical institutions has been realized to reach about 500,000; the third is hypertension, diabetes, and malignant tumors Outpatient chemotherapy, uremia dialysis, and organ transplantation 5 kinds of outpatient clinics and other 5 outpatient clinics, such as the full coverage of the slow special disease inter -provincial direct settlement and coordinating region, gradually gradually specially demand other people's needs and generally developed outpatient diseases in various places. Related treatment costs are included in the scope of direct settlement of cross -province; fourth is that the regulation of medical treatment is convenient; the fifth is to basically achieve online and offline medical insurance reimbursement.

It only takes three steps to enjoy medical insurance benefits across provinces

Question: How can insured persons settle directly across provinces?

Answer: Simply put, it is the first filing, selection point, and code card to seek medical treatment.

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.

Six types of people, long -lived and temporary medical treatment, can apply for filing

Q: Who can apply for a different place for medical treatment? Answer: The management system for medical treatment for different places is to confirm the identity of the insured person, distinguish the types of insured persons to go out for medical treatment, and determine the corresponding medical insurance treatment. The success rate of direct settlement of cross -province. At the same time, medical insurance shall be implemented to the medical insurance personnel, which is also the requirements for implementing national hierarchical diagnosis and treatment, and guides the reasonable and orderly medical treatment.

In the past, only four kinds of personnel in different places were resettlement of retirees, long -term residents in different places, resident staff, and referred personnel in different places. Different medical recorders are divided into two categories: long -term residents of inter -provincial and different places and temporary inter -provincial medical personnel, and further subdivided into 6 kinds of personnel. Among them, 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 lives outside the province for a long time. Due to work, travel and other reasons, the emergency rescue personnel in different places and other inter -provincial temporary medical treatment were temporarily used.

There are principles for reimbursement of inter -provincial medical reimbursement.

Q: What is the payment policy for direct settlement funds for cross -provinces and other places?

Answer: Inpatients, general outpatient and outpatient medical expenses for direct settlement, general outpatient and outpatient medical expenses for cross -provinces and different places. The relevant policies such as the starting standards, payment ratios, maximum payment limit, and the scope of slow special diseases of outpatient diseases stipulated in basic medical insurance funds stipulated in the insurance place are implemented. 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 payment is 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.

Source: Xinhua News Agency, People's Daily Economic and Social WeChat public account, copyright belongs to the original author.

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