People's Livelihood Through Train丨New regulations for cross-provincial medical treatment in different places. These rules are related to you and me

　　Xinhua News Agency, Beijing, July 26th.

　　Xinhua News Agency reporters Peng Yunjia, Gu Tiancheng, Mu Tiecheng

　　The National Medical Insurance Administration and the Ministry of Finance issued the "Notice on Further Doing a Good Job in the Direct Settlement of Basic Medical Insurance Cross-province and Out-of-Place Medical Treatment" on July 26, to uniformly standardize the details of the insured's out-of-town medical treatment filing, fund payment, and collaborative business. An insured person who needs to go out for medical treatment has an important impact.

How to apply for direct settlement of medical treatment across provinces?

　　To put it simply, it is to file a record first, select a point, and seek medical treatment with a code card.

　　Before seeking medical treatment in a different place, the insured can go through the online and offline channels such as the National Medical Insurance Service Platform App, the national remote medical treatment filing mini-program, the State Council client mini-program or the window of the handling agency in the participating place and other online and offline channels; after the filing is opened, The insured person can enjoy the inter-provincial direct settlement service of hospitalization expenses in all the inter-provincial networked designated medical institutions opened in the place of record; when seeking medical treatment, a valid certificate such as an electronic medical insurance certificate or a social security card is required.

　　The direct settlement and payment policy for cross-provincial medical treatment in different places can be understood as "the directory of medical treatment places and the policy of insured places".

　　That is to say, the scope of payment and relevant regulations stipulated by the place of medical treatment, including the scope of payment for basic medical insurance drugs, medical service items and medical consumables, etc.; Relevant policies such as quotas and the scope of chronic and special diseases in outpatient clinics.

How to apply for medical records in different provinces?

　　Except for emergency rescue personnel in different places, which are deemed to have been filed and do not need to submit materials, other personnel are required to provide medical insurance electronic certificates, valid ID cards or social security cards, and filing forms.

　　In addition, retirees who are resettled in other places need to provide the "Household Register" and their "Registration Card of Permanent Residents" or personal commitment; long-term residents in other places need to provide residence certificates or personal commitments; resident staff in different places need to provide work in the insured place The certificate of dispatch from the unit, the certificate of the non-local work unit, the work contract, or the personal commitment letter; the referral personnel in the non-local area must provide the referral and referral certificate issued by the designated medical institution specified in the insured place.

　　At present, all coordinating regions have opened the online registration service for remote medical treatment on the National Medical Insurance Service Platform App, the national remote medical treatment filing mini-program, and the State Council client mini-program. .

　　In addition, 120 co-ordination areas across the country have achieved self-service filing, and insured personnel can apply for it immediately and take effect immediately.

What are the precautions after filing?

　　After long-term residents living in different provinces and regions go through registration and filing, as long as they do not apply to change the filing information or the insurance status has not changed, the filing will be valid for a long time and there is no limit to the number of medical visits.

For people who temporarily go out for medical treatment across provinces, the temporary filing period is not less than 6 months. During the validity period, they can visit the doctor multiple times in the medical treatment place and enjoy direct settlement, and do not need to visit the doctor once for the filing.

　　At present, some co-ordination areas require more than one year after filing to cancel or change.

According to the new requirements in the notice, starting from January 1, 2023, the time limit for changing or canceling the filing in various places will not exceed 6 months.

　　For the insured who are too late to go through the filing, the notice clarifies that if the filing for off-site medical treatment is made before the settlement of discharge from the hospital, the designated medical institution in the network of medical treatment places should handle the direct settlement of medical expenses across provinces for the insured person.

If the insured person goes through the filing procedures according to the regulations after being discharged from the hospital and settles at his own expense, he can also apply for manual reimbursement of medical insurance according to the regulations of the insured place.

How to settle outpatient treatment for chronic diseases in other places?

　　The relevant person in charge of the National Medical Insurance Bureau said that at present, more than 200 coordinating regions across the country have realized the treatment costs for five outpatient chronic diseases, including hypertension, diabetes, radiotherapy and chemotherapy for malignant tumors, dialysis for uremia, and anti-rejection treatment after organ transplantation. Cross-province direct settlement.

　　According to reports, insured persons with outpatient chronic and special disease qualifications need to complete 5 steps to enjoy inter-provincial direct settlement services, including: the first step, to understand the individual's qualifications for outpatient chronic and special disease treatment; the second step, to take the initiative Understand the policies related to the cross-provincial direct settlement of outpatient chronic and special diseases in the insured place; the third step is to select and open the relevant outpatient chronic and special disease cross-provincial networked designated medical institutions; the fourth step, take the initiative to inform the networked designated medical institutions that they have outpatient chronic and special diseases Eligibility; Step 5: Hold the medical insurance electronic certificate or social security card for settlement as required.

What are the expansions of the direct settlement and reimbursement expenses for medical treatment in other places?

　　In response to the problems of out-of-hospital injuries, emergency rescue, and out-of-hospital expenses that are of concern to the masses, it is notified that the non-third-party liability trauma expenses that clearly meet the management regulations of the place of medical treatment can be included in the scope of direct settlement of cross-provincial out-of-town medical treatment; For inspection and treatment or purchase of medicines from designated pharmacies, the relevant expenses will be included in the inter-provincial direct settlement of the hospitalization expenses.

　　In addition, the notice allows inter-provincial long-term residents to enjoy treatment in both the place of filing and the place of participation.

　　Long-term residents living in different places in different provinces who really need to go back to the insured place for medical treatment within the validity period of the record can enjoy the medical insurance settlement service in the insured place.

　　The relevant policies will be officially implemented from January 1, 2023.