Reimbursement and settlement of outpatient and inpatient medical expenses of medical institutions in this Municipality's medical insurance agreement
(a) chronic diseases, special diseases designated outpatient drug treatment personnel, the insured need to prescribe drugs during the system switch, can be in 20021year before April 30 in designated medical institutions to prescribe drugs in advance. According to the condition, the maximum dosage can be one month. During the system switching period, such as prescription and treatment, the relevant expenses will be paid in advance by individuals in cash, and the new system will be settled in the original designated medical institutions after it goes online.
(2) For inpatients, medical insurance settlement will be suspended during system switching, and the designated medical institutions will make up the settlement after system switching.
(three) critically ill patients, outpatient treatment can be paid in cash first, and then to the insurance agency for reimbursement after the treatment.
If there are special circumstances, designated medical institutions should contact the medical insurance agency in time and make relevant explanations to the insured patients.
Procedures for medical treatment in different places
(1) Being hospitalized in a different place. During the downtime, if you can't file through the platform, you can directly go to a different place to go through the hospitalization procedures, and after the system is restored, you can go through the formalities of filing and admission registration for medical treatment in different places.
(2) seek medical treatment in different places. Insured persons seek medical treatment outside the city. If they need to go through discharge settlement during downtime, the insured can apply to the designated medical institutions for supplementary settlement after the system is restored, or they can return to the medical insurance agency in the insured place for reimbursement after paying the medical expenses in full.
Special note: If the insured person has completed the discharge settlement at the medical treatment place during the downtime, he/she should personally submit the relevant medical expenses to the medical insurance agency in Shijiazhuang, and provide the related materials such as charge invoice, expense details, copy of hospitalization medical records, and unit declaration form when submitting the reimbursement. During the downtime, the insured who goes to the insured place for medical treatment in different places will normally enjoy the relevant medical insurance benefits when they return to the insured place for manual reimbursement, regardless of whether they go to the other place for medical treatment.
(3) Information changes of people living in different places for a long time. During the downtime, the information of long-term residents in different places cannot be changed normally, and it will be processed after the system is restored.
Identification and filing of special diseases and special drugs
(a) for the insured who meet the criteria for the identification of special diseases, the special diseases that have been entrusted to the agreed medical institutions shall be identified by the recognized medical institutions according to the process; After the new system is put into use, the medical insurance department of medical institutions will re-enter the filing information according to the identification results of the Application Form for the Treatment of Chronic Diseases and Special Diseases in Outpatients (hereinafter referred to as the Application Form for Special Diseases). After the operation, the organ transplantation that needs anti-rejection treatment and the identification of special diseases of long-term residents in different places shall be reviewed by the competent doctor according to the process and the application form for special diseases shall be filled in. After the platform is successfully switched, the insured person will go to the medical insurance agency in the insured area to supplement the information with the relevant medical records such as the Application Form for Special Diseases.
(II) For the insured who meet the requirements of using special drugs, the responsible physician for special drugs shall first review (estimate) according to the process, fill in the Record Form for the Use of Special Drugs in Shijiazhuang Basic Medical Insurance (Evaluation Form) (hereinafter referred to as the Record Form for Special Drugs (Evaluation Form)), and the medical insurance department shall complete the examination and approval; After the platform switching is completed, the insured person will go to the medical insurance agency in the insured place to fill in the special drug filing form (evaluation form) and other related medical records.
Identification of chronic diseases
Since April 30th, the identification of chronic diseases has been suspended. At the same time, the application platform for chronic diseases such as "Shijiazhuang Medical Insurance" APP will be suspended, and the application opening hours will be notified separately.
maternity insurance
During the platform switching, the settlement of maternity medical expenses will be suspended, and the designated medical institutions will re-enter the settlement after the system switching is completed.
Transfer and connection of basic medical insurance for employees
(a) will be sent by the foreign agencies of the insured basic medical insurance coverage change information form "normal distribution to the insured units, to receive all the basic medical insurance transfer and continuation of the contact letter" summary records, until the information platform officially launched in order to handle;
(2) During the platform switching period, employees' basic medical insurance relationship transfer, application for basic medical insurance relationship transfer and connection letter and business connection will be suspended until the information platform is officially launched.
Employee insurance registration business
During the platform switching, the new enrollment, enrollment registration, information change and inquiry of companies and individuals are suspended. After the platform is switched, the collection period mode will be notified separately.
accident
During the system switching, the settlement of accidental injury medical expenses is suspended, and after the system switching is completed, the designated medical institutions will settle again.
Contact telephone numbers of institutions at all levels and accidental injury insurance
(a) contact telephone number of institutions at all levels:
1. Shijiazhuang Medical Insurance Center: Off-site Medical Management Section: 83865466;
Department of Chronic Diseases and Special Diseases Management, Shijiazhuang Medical Insurance Center: 66188086;
Physical examination department of Shijiazhuang medical insurance center staff: 83865076;
Comprehensive Department of Urban and Rural Residents of Shijiazhuang Medical Insurance Center: 83865337;
Shijiazhuang Medical Insurance Center Maternity Insurance Physical Examination Department: 83827096;
Shijiazhuang Medical Insurance Center Medical Insurance Relationship Transfer and Continuation Department: 83865050;
Shijiazhuang Medical Insurance Center Staff Participation Section: 83865090.
2 counties (cities, districts):
Shenze County: Insurance Department and Physical Examination Department: 69136112;
Pingshan county: insurance department: 89112003;
Physical examination department: 89112221;
Gaocheng District: Insurance Department: 88 166009 (residents) and 88046043 (employees);
Physical examination department: 88 16 106 (resident) and 88049255 (employee);
Luancheng District: Insurance Department: 8803 1460, 88035109;
Physical examination department: 85539106;
Gaoyi County: Insurance Department and Physical Examination Department: 84035529;
Yuanshi County: Insurance Department and Physical Examination Department: 84626838;
Jinzhou City: Insurance Department: 84336932;
Physical examination department: 84319173;
Wuji County: Insurance Department: 85582303 (residents) and 85576323 (employees);
Physical examination department: 85572611;
Lingshou County: Insurance Department: 82968092;
Physical examination department: 82968887;
Zhaoxian: Insurance Department and Physical Examination Department: 8729 155 1 (employees) and 8729 1550 (residents);
Jingxing County: Insurance Department: 82022004;
Physical examination department: 82036909;
Zanhuang County: Insurance Department and Physical Examination Department: 87 192589 (residents) and 84226589 (employees);
Zhengding county: insurance departments: 88020236, 88020238 (employees), 880 1 1990 (residents);
Physical examination department: 88020057;
Luquan District: Insurance Department: 820 14995 (residents), 820 12952 (newborns), 8201/239 (employees);
Physical examination department: 8201281(resident), 8201912 (employee);
Xingtang County: Insurance Department: 82992787;
Physical examination department: 8298 1722 (resident) and 82983556 (employee).
Xinle City: Insurance Department: 88679779;
Physical examination departments: 88595075 (employees) and 88597087 (residents); Chang 'an District: Insurance Department: 66023653, 66023631;
Physical examination departments: 85996873 (residents), 85996672, 85995763 (employees and flexible employees);
Yuhua District: Insurance Department: 66501551;
Physical examination department: 66501552;
Qiaoxi district: Insurance Department: 68005079;
Physical examination department: 68005083;
Xinhua District: Insurance Department: 86952626;
Physical examination department: 87855161;
High-tech Zone: Insurance Department: 85096065;
Physical examination department: 85096062;
Jingxing mining area: Insurance Department and Physical Examination Department: 85417063;
Circular Chemical Industry Park: Insurance Department and Physical Examination Department: 69096676;
(2) Contact number of accident insurance:
1. qiaoxi district, a city-level (college student) insured urban and rural resident, tel: 83865701;
For urban and rural residents in Luancheng District and Luquan District, the telephone number is 85983229;
Pingshan County insured urban and rural residents, Tel: 82895079;
Yuanshi County insured urban and rural residents, Tel: 84629822;
2. Urban and rural residents in Lingshou County are insured, tel: 69135916;
The telephone number of the insured urban and rural residents in Gaocheng District is 88166186;
Insured urban and rural residents in Xinhua District, Gaoyi County, Tel: 83865095; Urban and rural residents in the mining area are insured, and the telephone number is 8208082;
Urban and rural residents in Zhengding County are insured, tel: 88295519;
Urban workers in Yuhua District, Xinhua District, qiaoxi district, Chang 'an District, High-tech Zone, Luquan District, Gaocheng District, jingxing mining area, Luancheng District, Circular Chemical Industry Park and Zhengding County, tel: 83865730;
3. Urban and rural residents insured in Xingtang County, Yuhua District, High-tech Zone, Shenze County, Zhao County and Wuji County. Tel: 86270045;
4. The telephone number of urban and rural residents insured in Zanhuang County, Xinle City, Jingxing County, Chemical Industry Park, Chang 'an District and Jinzhou City is 660 193 1 1.