Summary of medical treatment in different provinces and places in Ningxia
Q: What is the direct settlement of medical treatment across provinces and different places?
Answer: Direct settlement of medical treatment in different provinces refers to the direct settlement of medical expenses incurred by insured persons of basic medical insurance after they are hospitalized in designated medical institutions outside the province with social security cards and go through the registration procedures for medical treatment in different places.
Q: Who can enjoy the direct settlement of medical treatment in different provinces?
A: There are four categories of people who can enjoy direct settlement of medical treatment across provinces and different places, namely retirees resettled in different places, long-term residents in different places, overseas workers and those who meet the referral conditions; According to the national arrangement, the direct settlement of hospitalization expenses for retirees resettled in different places will be gradually solved in 20 17 years, and the direct settlement of hospitalization expenses for those who meet the referral conditions will be expanded at the end of the year. Combined with the reform of household registration and residence permit system, long-term residents and permanent residents in different places will be gradually included in the direct settlement of medical expenses in different places.
Q: How to file a cross-provincial medical treatment?
A: The filing system is implemented for medical treatment in different provinces. Insured persons who seek medical treatment in different places can register with the social security agency in the insured place, or log on to the website for the record.
(a) resettlement, long-term residence in different places, long-term residence in different places, fill in the information required by the Registration Form for Medical Treatment in Different Places of Basic Medical Insurance, and go through the filing formalities with my social security card and related materials (proof of residence or work in different places) at the social security agency of the insured place.
(2) The insured who meets the referral conditions shall go through the filing formalities with the social security agency of the insured place with the basic medical insurance referral book and my social security card.
(III) Malignant tumor, organ transplantation, postoperative and dialysis inpatients, with my social security card and disease diagnosis certificate or hospitalization medical records, go directly to the social security agency in the insured area to go through the inter-provincial medical registration procedures according to the referral.
If the information such as residence, designated medical institutions, and contact telephone number of the personnel who have completed medical treatment in different places changes, or the referral personnel are transferred or admitted to the hospital again during medical treatment in different places, they shall directly apply to the social security agency of the insured place for change.
The insured person can also log in to the online service hall of Ningxia Human Resources and Social Security (self-service for filing and changing in different places), complete the information entry of inter-provincial medical registration and filing in different places, upload relevant certification materials, and go through the formalities for changing the inter-provincial medical registration and filing after being confirmed by the agency in the insured place.
Q: What is the inter-provincial medical certificate?
A: The social security card is the only proof for the insured to identify and directly settle the medical treatment in different places. It should be emphasized that when the insured person applies for inter-provincial medical treatment for the first time, it is necessary to check the social security card out of the province at the social security agency of the insured place to ensure that the insured person can normally seek medical treatment across provinces.
Q: At present, which areas in Ningxia can realize direct settlement of medical treatment across provinces and different places?
A: Up to now, the provinces that have achieved direct settlement of hospitalization expenses in different places by networking with the national platform are: Beijing, Tianjin, Hebei, Hainan, Yunnan, Chongqing, Xianning, Hubei, Zhejiang (provincial level, Yiwu), Jilin, Benxi, Liaoning, Xinjiang (district level, Bozhou), Jiangsu (Suqian, Yancheng, Xuzhou, Lianyungang, Huai 'an, Taizhou, etc. Anhui (provincial, Chuzhou, Huangshan, Maanshan), Shaanxi, Heilongjiang, Ningxia, Qinghai, Hunan, Henan, ***22 provinces. At present, there are more than 500 designated medical institutions (the insured can visit the online service hall of human resources and social security in Ningxia, or call 12333). Insured persons in Ningxia can seek medical treatment in the above-mentioned designated medical institutions across provinces and regions, and can realize direct settlement. With the successful docking test between more regions and the national remote settlement platform, the scope of inter-provincial designated medical institutions will gradually expand.
Q: What are the first batch of inter-provincial designated medical institutions open to the outside world in our region?
A: At present, there are four designated medical institutions/KLOC-0 in our region, covering five cities in the region. They are: General Hospital of Ningxia Medical University, Cardiovascular and Cerebrovascular Hospital of General Hospital of Ningxia Medical University, Ningxia People's Hospital, Xixia Hospital of Ningxia People's Hospital, Ophthalmology Hospital of Ningxia People's Hospital, Chinese Medicine Hospital of Ningxia Hui Autonomous Region, First People's Hospital of Yinchuan City, Chinese Medicine Hospital of Yinchuan City, First People's Hospital of Shizuishan City, Second People's Hospital of Shizuishan City, Fifth People's Hospital of Autonomous Region, wuzhong People's Hospital, Guyuan People's Hospital and zhongwei People's Hospital. In the next step, our district will gradually expand the scope of designated medical institutions across provinces.
Q: How to realize direct settlement of medical treatment across provinces?
A: The direct settlement of medical treatment across provinces and different places is based on the principle of "using the catalogue of medical treatment places, implementing the management of medical treatment places, implementing the policy of insured places, clearing the points of national platforms and clearing them at provincial and municipal levels". The medical expenses incurred by the insured in the inter-provincial designated medical institutions at the place of medical treatment only need to be paid by individuals, and the overall payment of medical insurance is settled by the social security agency at the place of medical treatment. Then, the national platform sorts out the medical expenses in different provinces on a monthly basis, and the provincial social security institutions in the insured areas and the social security institutions in the insured areas carry out liquidation, and the liquidation funds are allocated by the provincial finance.
Q: How is the payment policy for cross-provincial medical treatment in our region stipulated?
A: According to the principle of "the list of medical places and the policy of insured places" proposed by the state, the payment scope of medical places (the list of basic medical insurance drugs, diagnosis and treatment items and medical service facilities standards) is implemented across provinces, and the minimum payment standard, payment ratio and maximum payment limit of the basic medical insurance pooling fund are implemented. On June 20 17, 17, our district issued a unified inter-provincial medical insurance payment policy.
The insured persons of basic medical insurance for urban workers seek medical treatment in designated medical institutions across provinces and regions outside the autonomous region. The qifubiaozhun of the first, second and third level designated medical institutions are 300 yuan, 500 yuan and 1200 yuan respectively, and the proportion of medical expenses paid within the scope of medical insurance policy is 95%, 90% and 80% respectively. The maximum annual payment limit for basic overall planning is 50,000 yuan, and the expenses exceeding 50,000 yuan within the scope of medical insurance policy enter large subsidies, including 350,000 yuan. Medicaid for civil servants is temporarily implemented according to the relevant policies of each region in this region.
The insured persons of basic medical insurance for urban and rural residents seek medical treatment in designated medical institutions outside the autonomous region. The qifubiaozhun of first-class designated medical institutions is 200 yuan, and the proportion of first-,second-and third-class payment is 85%, 90% and 95% respectively. The qifubiaozhun of secondary designated medical institutions is 400 yuan, and the proportion of primary, secondary and tertiary payment is 80%, 85% and 90% respectively. The minimum payment standard of tertiary designated medical institutions is 1 1,000 yuan, and the proportion of primary, secondary and tertiary payment is 45%, 60% and 65% respectively. The annual maximum payment limit of basic medical insurance for urban and rural residents is 70,000 yuan, 6,543.8+0.2 million yuan and 6,543.8+0.6 million yuan respectively according to the first, second and third grades. The payment ratio and payment limit of serious illness insurance for urban and rural residents are consistent with the local area.
Q: How is the direct settlement of medical treatment across provinces and different places arranged and implemented?
A: According to the national arrangement, the direct settlement of cross-provincial medical treatment in different places follows the principle of "step by step, five before five", that is, first within the province, then across provinces, first after hospitalization, first after resettlement in different places, then referral to other hospitals, first after basic medical insurance, then supplementary insurance, combined with the actual situation of local system construction, giving priority to connecting areas where medical treatment in different places is concentrated, and steadily and comprehensively promoting the direct settlement work. At present, the direct settlement of inter-provincial hospitalization expenses is mainly carried out, and the basic overall planning, large-scale Medicaid and civil servant Medicaid are included in the direct settlement of inter-provincial hospitalization expenses in our district. In the next step, in accordance with the unified national arrangements, our district will steadily promote direct settlement of medical treatment across provinces and expand the scope of settlement of medical treatment in different places.
Q: When can urban and rural residents realize direct settlement of medical treatment across provinces and different places?
A: According to the unified deployment of Ministry of Human Resources and Social Security, at this stage, it is mainly to directly settle the medical expenses of retirees who are resettled in different places to participate in employee medical insurance. In the next step, combined with the reform of household registration and residence permit system, Ministry of Human Resources and Social Security will gradually bring urban and rural residents into the direct settlement coverage of hospitalization medical expenses in different places. Our district will follow up the deployment in time and announce it to the public as soon as possible.