According to the person in charge of the Municipal Medical Insurance Center, after consultation with the medical insurance agencies in the four places, the Guangzhou Medical Insurance Service Window was set up in the office areas of the medical insurance agencies in these four independent areas, and the Guangzhou Medical Insurance Center sent people to handle the medical insurance business of the medical insurance participants in Guangzhou on the spot. The scheme has been tried out since April, with a monthly schedule of 1 day in the trial stage, accepting Guangzhou's medical treatment, work-related injury and maternity insurance policy consultation and medical insurance treatment complaints, sporadic medical expenses reimbursement for unemployment insurance participants, confirmation of medical certificates for maternity insurance participants, application for specific outpatient programs and approval of chronic disease treatment for participants in different places.
At the same time, the special window accepts the business reports of designated medical institutions of social insurance in Guangzhou, the confirmation of medical treatment for insured persons of medical insurance and maternity insurance in Guangzhou, the confirmation of medical treatment for insured persons in different places, and the appointment of medical insurance cards. Insured units, insured persons and medical institutions designated by medical insurance need the above services, and they only need to bring relevant materials and handle them at the special window from Monday to Thursday at 9: 00-16: 30 in the second week of each month (except holidays, the noon service hours refer to the external service hours of local medical insurance agencies).
Monday
Huadu district medical treatment insurance office
Labor insurance bureau located in Chengxin Road.
Tuesday
Conghua medical treatment insurance center
54 Xincheng East Road
Wednesday
Zengcheng medical treatment insurance center
No.0/8, Li Xing Road, Licheng Street.
Thursday
Panyu district medical treatment insurance office
Floor 5, Building 3, No.48 Kanglu Road, Shiqiao City
Conghua medical insurance participants can also go to Guangzhou for medical reimbursement! The reporter was informed yesterday that a few days ago, Conghua Medical Insurance Center and the Second Affiliated Hospital of Guangzhou Medical College held the opening ceremony of the instant settlement system. In the future, all Conghua medical insurance participants hospitalized in the Second Hospital of Guangzhou Medical University will be discharged after settling their own expenses and out-of-pocket expenses, just like the designated hospitals in Conghua, eliminating many inconveniences such as checkout and reimbursement.
It is understood that since 2006, all insured persons who have visited the designated medical insurance hospitals in Conghua 15 have enjoyed the real-time settlement service for hospitalization. However, because Conghua medical insurance is different from Guangzhou in terms of payment level, treatment level and settlement method, in recent years, medical insurance management has adopted a relatively independent computer system, which failed to realize network docking with hospitals in Guangzhou in time.
Recently, Conghua Medical Insurance Center is connected with the instant settlement network system of the Second Hospital of Guangzhou Medical University, which will facilitate the insured to go to Guangzhou for reimbursement. According to the relevant person in charge of Conghua Medical Insurance Center, in the future, all insured persons hospitalized in the Second Hospital of Guangzhou Medical University will be discharged after paying their own expenses and out-of-pocket expenses, just like those in the designated hospitals in Conghua City. As for the part that belongs to medical insurance reimbursement, the medical insurance center will directly settle with the Second Hospital of Guangzhou Medical University afterwards.
Conghua Medical Insurance Center said that it will continue to work hard to reach an understanding with other hospitals in Guangzhou, and strive to successfully connect with many hospitals on the real-time settlement network system to effectively solve the problem of people seeking medical treatment.
In fact, it seems that medical insurance cannot be transferred, so we can only go to different places for medical treatment. The following are questions and answers about medical treatment in different places.
67. Q: What conditions can people who meet apply for medical treatment in different places?
Answer: Insured persons who work or live in different places outside the city for a long time can apply for medical treatment in different places. For example: settle in different places after retirement; Troops stationed in the wild for a long time.
Insured persons suffering from mental illness who apply for medical treatment in different places shall submit a written application to Conghua Medical Insurance Service Management Center, which can only be handled after approval.
68. Q: How to register for medical treatment in different places?
Answer: (1) Fill in the Application Form for Confirmation of Persons Working (Living) in Different Places in Conghua City in duplicate;
(2) Provide a copy of the insured's ID card and medical insurance card (front and back);
(3) Reimbursed medical expenses shall be directly transferred to the passbook of the insured in Liuxi Sub-branch of Agricultural Bank of Conghua City or the passbook of the Postal Savings Office, and a copy of the first page of the passbook shall be provided.
69. Q: What should the insured pay attention to when he is admitted to hospital due to illness after completing the application for medical treatment in different places? How to reimburse hospitalization expenses after discharge?
Answer: You should seek medical treatment in a registered medical institution and report to the medical insurance center for filing within 5 working days after admission (content: name, gender, ID number, date of admission, hospital name and grade). You can register and put on record by telephone at 020-87920252 or fax at 020-87924339.
At the time of discharge settlement, the medical expenses shall be paid by myself first. After discharge, the medical expenses shall be reimbursed to the basic medical department of the medical insurance center as soon as possible with the detailed list of medical expenses, the invoice printed by the finance and taxation department, the discharge or diagnosis certificate, the copy of the front and back of the medical insurance card and the copy of the ID card, the copy of the application form for medical treatment in different places, the discharge summary (others need to provide the original and copy of the ID card) and other materials (the reimbursement standard refers to the proportion of designated hospitals at the same level).
For example, in-service insured persons who have been working in different places for a long time need to be hospitalized due to illness. After reporting to our center for the record, they will go to designated hospitals (level 3) in different places for medical treatment. The total cost of hospitalization is 8000 yuan. After the patient recovers, prepare his own relevant materials and come to our center for sporadic reimbursement. How to reimburse hospitalization expenses?
Answer: I have paid the total hospitalization expenses of the insured. When the expenses are reimbursed sporadically, the basic medical insurance department will review the medical expenses and get the self-funded expenses *** 1200 yuan;
The deductible for tertiary hospitals is 2000 yuan.
The fee for entering the * * * payment section is 8000-2000- 1200 = 4800 yuan.
* * * Personal expenses during the payment period are: 4,800× (1-80%) = 960 yuan.
Individual contribution is 2000+1200+960 = 4160 yuan.
Medical insurance payment 4800-960 = 3840 yuan.
Therefore, the medical insurance pooling fund should allocate 3840 yuan to the insured's bank account.
For example, retirees who live in different places for a long time need hospitalization after illness, and they will be admitted to the local tertiary hospital after reporting to our center for the record. The total cost of hospitalization is 8000 yuan. Q: How much medical expenses can the insured reimburse?
A: The insured person is hospitalized according to the regulations and reimbursed sporadically. After the detailed list of medical expenses was audited by the basic medical department, it was concluded that his own expenses were 1.200 yuan;
Deductible line of tertiary hospital 1400 yuan.
The fee for entering the * * * payment section is 8000-1400-1200 = 5400 yuan.
* * * Personal expenditure during the payment period is: 5400× (1-86%) = 756 yuan.
Individual contribution1400+1200+756 = 3356 yuan.
Medical insurance payment 5400-756 = 4644 yuan.
Therefore, the medical insurance pooling fund should be transferred to the insured's bank account of 4644 yuan.
70. Q: Can medical expenses be reimbursed for hospitalization during business trip, study, travel and visiting relatives?
A: You need to go through the confirmation procedures for medical treatment in different places. The insured person or unit or their relatives shall report to the municipal medical insurance service management center for the record within 5 working days after the insured patient is admitted to the hospital. They can register by phone or fax. Call 020-87920252 or fax 020-87924339 (content: name, gender, ID number, date of admission, hospital name and grade), and pay the medical expenses first. If you fail to go through the formalities for confirmation and filing of medical treatment in different places within the specified time, all medical expenses will be paid by yourself, and the overall fund will not pay. There are special reasons, with the approval of the municipal medical insurance service management center, the proportion of payment in each paragraph of the overall fund will be reduced by 30%.