Hot wire£¡ The county residents come to the city to see a doctor without any more money.
6 days, the reporter learned from the Ji'nan social security bureau that the Ji'nan city staff medical insurance network settlement system has been completed. From January 1st this year, Zhangqiu, Jiyang, Shanghe, Pingyin and other counties (cities) workers medical insurance participants in the urban area Doctors will enter the era of network settlement, the insured person only needs to pay part of the personal burden when he is discharged from the hospital. It is not necessary to pay the full medical expenses and remove the formalities of cash reimbursement after discharge.
a few days ago, a worker in Shanghe County settled the municipal infectious disease hospital successfully and became the first example of the city's interconnection settlement. According to the statistics of the Municipal Social Security Bureau, at present, the employees of the county (city) have come to seek medical treatment, and the first choice hospitals are provincial and municipal tertiary hospitals. Therefore, the Municipal Social Security Bureau first opened instant networking settlement for 13 hospitals, including provincial hospitals, Qilu Hospital, Qilu Hospital, Qilu Hospital, Provincial Traditional Chinese medicine, Qianfo Hill hospital, military area general hospital, Central Hospital, Eastern Hospital of provincial hospital, provincial hospital of infectious disease, provincial Chest Hospital, provincial transportation hospital, Western Hospital of provincial hospital and provincial cancer hospital. Participate in medical treatment.
the staff of the Social Security Bureau said that the city, Zhangqiu, Jiyang, Shanghe and Pingyin were divided into five medical insurance zones in Ji'nan because of the historical reasons of the medical insurance system. Before 2016, the medical insurance system could not be settled out of the overall planning area. When the insured people went to the large hospital in the urban area, they needed to transfer the hospital through the transfer procedures, and the individual had to cover the medical expenses in full. After discharge, return to the medical insurance agency of the county or county office for reimbursement, and the pressure of the funds is large and the procedures are complicated. Through the design, development and completion of the Zhangqiu trial operation network settlement system, the insured workers in each county can achieve networking settlement in 13 hospitals in Ji'nan.
municipal, Zhangqiu, Jiyang, Shanghe, Pingyin
provincial hospital, Qilu Hospital, Qilu Hospital, provincial hospital of traditional Chinese medicine, Qianfo Hill hospital, military area general hospital, Central Hospital, provincial hospital, municipal infectious disease hospital, provincial Chest Hospital, Province Transportation hospital, provincial hospital, West Hospital, provincial cancer hospital
before January 1st and > before January 1st, the medical insurance system can not be settled by the medical insurance system. When the insured people go to the metropolitan hospital, they need to pass through the transfer procedures, and the individual should cover the medical expenses in full. After discharge, return to the medical insurance agency of the county or county office for reimbursement, and the pressure of the funds is large and the procedures are complicated.
after January 1st, the insured person has a non card certificate issued by the local medical insurance agency, with the certificate and ID card, and the immediate settlement at the discharge.
how to reimburse the hospitalization expenses?
the staff of the County District, before the medical treatment, have no card certificate issued by the local medical insurance agency, holding the certificate and ID card, and the immediate settlement at the discharge. The reimbursement policy is implemented in Ji'nan's "three major catalogues" and reimbursement policy is still implemented.
What are the "three catalogues"?
"three catalogues" is the general term of the scope of the list of basic medical insurance drugs for staff and workers, the catalogue of diagnosis and treatment items and the medical service facilities. At present, according to the "Shandong provincial basic medical insurance, industrial injury insurance and birth insurance drugs catalogue (2010 Edition)", "Shandong provincial urban staff and workers basic medical insurance project catalogue" and "Shandong province urban workers basic medical insurance medical service facilities project scope" ([2001]2 No.
according to the "three major catalogues" and related regulations, the coverage of medical insurance includes two categories, which are paid by the CO ordinating fund and partially paid by the CO ordinating fund. The medical insurance fund does not pay the content outside the three major catalogues. What are the advantages of
networking settlement?
realize the network settlement, the insured person deals with the expense of the personal negative part of the hospital with the hospital, without full payment of the hospitalization expenses, and does not need to go through the cash reimbursement formalities with the social security agency. In the traditional cash reimbursement model, it is effective to improve the pressure of the insured and the difficulty of running the leg back and forth, and also to improve the efficiency of the social security agencies.
this networking includes out-patient co-ordination?
April 1, 2014, "basic medical insurance measures for Ji'nan workers" has been formally promulgated and implemented, which has increased the policy of "out-patient co-ordination". From then on, there are two safeguard forms of "door rules" and "outpatient co-ordination" in the treatment of medical insurance in Ji'nan. The direction is to solve the "small disease" outpatient medical care reimbursement problem through the overall outpatient service through the outpatient clinic, and to solve some special diseases and "serious illness" outpatient care reimbursement problem through the door rules. This networking, excluding out-patient co-ordination.