For the convenience of Guangzhou coordinated area insured units and participants in Panyu, Huadu, Zengcheng, Conghua four places close to the Guangzhou health insurance business, from April, the Guangzhou Municipal Health Insurance Center will be in Huadu, Panyu, Zengcheng, Conghua health insurance agencies to set up a special window of the Guangzhou health insurance services.

According to the person in charge of the Municipal Health Insurance Center, after consultation with the four local health insurance agencies, a special window for Guangzhou health insurance service will be set up in the office area of the health insurance agencies in these four independent integrated areas, and the Guangzhou Health Insurance Center will send people to handle the health insurance business of Guangzhou health insurance participants on the spot. This program will be implemented on a trial basis from April, and one day per month will be arranged during the trial period to handle Guangzhou's medical, industrial injury and maternity insurance policy inquiries and complaints about medical insurance treatment, reimbursement of sporadic medical expenses for unemployment insurance participants, confirmation of medical vouchers for maternity insurance participants, and approval of application for outpatient specific items and outpatient chronic disease treatment for outpatient medical insurance participants from other places.

The special window also accepts business statements of Guangzhou social insurance designated medical institutions, confirmation of off-site medical treatment for Guangzhou health insurance and maternity insurance participants, confirmation of off-site medical treatment for foreign participants choosing designated medical institutions in Guangzhou, and booking of appointment for issuance of medical insurance cards and other formalities and businesses. The insured units, insured persons and designated medical institutions for the above services can be handled at the special window from Monday to Thursday of the second week of each month from 9:00 to 16:30 (except for holidays, the service time at noon refers to the external service time of the local medical insurance agencies) by bringing along all the relevant information.

Monday

Huadu District Health Insurance Office

Chengxin Road, Gongcheng Road, inside the Labor Insurance Bureau

Tuesday

Conghua Health Insurance Center

No. 54, Xincheng East Road

Wednesday

Zengcheng City Health Insurance Center

No. 18, Lixing Road, Licheng Street

Thursday

Panyu District Medical Insurance Office

Shiqiao City Kang Road, No. 48, Building 3, 5th Floor

Conghua's health insurance participants can also go to Guangzhou City District medical reimbursement! The reporter learned yesterday that a few days ago, Conghua health insurance center and the Second Affiliated Hospital of Guangzhou Medical College held an instant settlement system opening ceremony. In the future, all the hospitalized in the second hospital of Guangzhou Medical College, from the medical insurance participants, medical settlement with the same designated hospitals in Conghua, clear out-of-pocket expenses and self-payment can be discharged, thus eliminating the settlement and reimbursement of a lot of inconvenience.

It is understood that since 2006, all the participants in the 15 health insurance designated hospitals in Conghua have enjoyed the real-time settlement of hospitalization services. However, because Conghua City health insurance in the level of contributions, treatment levels and settlement methods and other aspects are different from the Guangzhou City District, so the health insurance management in recent years have used a relatively independent computer system, and failed to timely with the hospitals in Guangzhou to achieve network docking.

The docking of the instant settlement network system between the Conghua Health Insurance Center and the Second Hospital of Guangzhou Medical College will facilitate the reimbursement of hospitalization claims of the insured in Guangzhou. The person in charge of Conghua Medical Insurance Center introduced that all the insured who are hospitalized in the Second Hospital of Guangzhou Medical College in the future can be discharged from the hospital after clearing the out-of-pocket expenses and self-payment part of the payment when they settle the medical bill, just like the fixed hospitals in Conghua. As for the reimbursement part of the medical insurance, the medical insurance center will be directly settled with the hospital afterwards.

Conghua City Medical Insurance Center said it will continue to fight with other hospitals in Guangzhou to reach **** knowledge, and strive to successfully docking with a number of hospitals instant settlement network system, to effectively solve the problem of the masses of medical problems.

In fact, it seems that the medical insurance can not be transferred, but only for foreign medical treatment. The following are questions and answers related to medical treatment in other places.

67, Q: What conditions can people meet to apply for medical treatment in a different place?

A: Participants who work or live in a different place outside the city for a long time can apply for medical treatment in a different place. For example: those who have settled in a different place after retirement; and those who are permanently stationed outside the city.

An insured person suffering from mental illness who applies for medical treatment in a different place must submit a written application to the Conghua Municipal Health Insurance Service Management Center, and the application will be processed only after approval and consent.

68. Q: How do I register for medical treatment in a different place?

A: (1) Fill in two copies of the Application Form for Confirmation of People Working (Residing) in Different Places in Conghua City;

(2) Provide a copy of the participant's ID card and a copy of the medical insurance card (front and back);

(3) Reimbursement of the medical expenses will be directly transferred into the participant's bank passbook in the Liuxi Sub-branch of the Agricultural Bank of Conghua City or the passbook of the Postal Savings Institute, and provide the copy of the first page of the passbook.

69. Q: What should the insured pay attention to when they are admitted to hospital for illness after completing the application for medical treatment in a different place? How to reimburse the hospitalized medical expenses after discharge?

A: The participant should seek medical treatment in the medical institution that has been declared and registered, and should report to the medical insurance center for record within 5 working days after admission (content: name, gender, ID card number, date of admission, name and level of the hospital), and can be registered by phone 020-87920252 or by fax 020-87924339 for the record.

When you are discharged from the hospital, the medical expenses will be advanced by yourself first, and then you can go to the Basic Medical Care Section of the Medical Insurance Center as soon as possible after you are discharged from the hospital with the detailed list of the medical expenses, the invoice printed by the Finance and Taxation Department, the certificate of discharge or diagnosis, a copy of the front and back of the medical card, a copy of the ID card, a copy of the application form for medical treatment in a different place, and the summary of the discharged medical expenses (if someone else has done it on behalf of you, you need to provide an original ID card and a copy of the ID card) to get reimbursement for the medical expenses. Reimbursement of medical expenses (the reimbursement rate will be based on the rate of the designated hospitals of the same level).

For example: an active participant who works in a different place for a long time and needs to be hospitalized due to illness, reports to the center for record, and then seeks medical treatment in the designated hospital (level 3) in the different place he declared. The total cost of hospitalization is 8,000 RMB, and the patient will come to the Center for piecemeal reimbursement after recovery with all the relevant information. How is the hospitalization cost reimbursed?

Answer: The total hospitalization cost of the insured person has been advanced by himself, and when reimbursed sporadically with the detailed list of his hospitalization cost, the basic medical insurance section will do the audit of medical cost and come up with the out-of-pocket cost of ****1,200 yuan;

The starting line of the tertiary care hospital is 2,000 yuan

Entering into the ****payment section of the cost of 8,000-2000-1200=4,800 yuan. 2000-1200 = 4800 yuan

***Payment section of the individual's out-of-pocket expenses for: 4800 × (1-80%) = 960 yuan

Individuals to pay the cost of 2,000 + 1,200 + 960 = 4,160 yuan.

Medicare paid 4800 - 960 = 3840 yuan

Therefore, the health insurance fund should transfer 3840 yuan to this participant's bank account.

For example: a retiree living in a different place for a long time and needing to be hospitalized after falling ill, declared for the record of the Center and stayed in a local tertiary hospital. The total cost of hospitalization is 8,000 yuan. Q: How much medical expenses can this participant be reimbursed?

A: The participant was hospitalized according to the regulations and made sporadic reimbursement, and the detailed list of his medical expenses was audited by the Basic Medical Care Section: his out-of-pocket expenses were 1,200 yuan;

The starting line of the tertiary hospital was 1,400 yuan.

The cost of entering the ****payment section is 8000-1400-1200 = 5400 yuan

The personal out-of-pocket expenses in the ****payment section are 5400 × (1-86%) = 756 yuan

The personal out-of-pocket expenses are 1400 yuan +1200+756=3356 yuan

The health insurance payment is 5400-756=4644 yuan

Therefore, the health insurance fund should transfer 4644 yuan to this participant's bank account.

70. Q: Can I be reimbursed for medical expenses when I am hospitalized during business trips, study trips, tours or family visits?

A: subject to confirmation procedures for foreign medical treatment, the insured person or unit or his relatives should be reported to the Municipal Health Insurance Service Management Center within five working days after the insured patient hospitalization for the record, can be registered by phone or fax, for the record telephone: 020-87920252 or fax 020-87924339 (content: name, gender, identity card number, date of admission to the hospital, the name of the hospital and level), the medical costs first advance the person's own medical expenses? ), the medical expenses will be advanced by the person himself first, and then he will go to the Municipal Medical Insurance Service Management Center for examination and reimbursement with the certificate of the unit (or the certificate of the family visit leave), the discharge settlement list, the medical record and other relevant information. If you don't go through the procedure of confirming and filing for medical treatment in other places according to the specified time, the medical expenses will be paid by yourself, and the integrated fund will not pay for them. If there is a special reason, the payment ratio of each section of the integrated fund will be reduced by 30% after examination and approval by the Municipal Medical Insurance Service Management Center.

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