1, bring the medical insurance card, medical insurance, ID card, referral slip and admission ticket to the medical insurance center for filing.
2. Go to the inpatient department for hospitalization.
Second, the emergency procedures:
1. If the insured person needs to be transferred outside the city for treatment due to illness, the director of the three-level designated medical institution shall put forward and fill in the Approval Form for Outside Referral of Basic Medical Insurance for Urban Residents.
2, the designated medical institutions by the medical insurance office audit, reported to the municipal medical center for approval, for referral procedures.
3. For the medical expenses that meet the requirements, the proportion of medical insurance fund payment will be reduced by 10 percentage point on the basis of the medical payment standard stipulated by this Municipality.
Three. Settlement procedure:
(1) Settlement procedure for inpatient and outpatient treatment of special diseases: Before each month 10, the designated medical institutions will report the expense list, hospitalization list and related materials of patients discharged from the hospital last month to the medical insurance agency, which will be used as the basis for monthly pre-allocation and year-end final accounts after examination. The medical insurance agency pre-allocated the hospitalization and outpatient expenses for special diseases last month. Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.
(2) Emergency settlement procedure: The medical expenses incurred by the insured in emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall go through the reimbursement procedures according to the provisions with the hospital emergency medical records, inspections, laboratory tests, invoices and detailed list of medical expenses.
(three) settlement procedures for resettlement personnel in different places:
1. The designated medical institution designated as 1-2 by the unit where employees are resettled in different places shall be reported to the medical insurance agency for the record.
2. The medical expenses incurred by the off-site staff in the outpatient department of the designated medical institution where the disease occurs at the place of residence shall be paid in advance by themselves or their units. After the treatment, the unit shall settle the diagnosis and medical records, effective expense bills, compound prescriptions and hospitalization expense lists of the insured. Go to the social medical insurance agency on the specified date.
(4) Referral settlement:
1. If the insured person is transferred to other medical institutions for diagnosis and treatment due to the conditions of designated medical institutions or specialized diseases, the approval form for referral and transfer shall be filled in. The reason for referral and transfer is put forward by the attending physician, the director of the department puts forward the opinion of referral and transfer, the medical institution medical insurance office reviews it, the dean in charge signs it, and it can be transferred only after being reported to the municipal medical insurance center for examination and approval.
2. In principle, referrals should be made outside the city, inside the province and outside the province. The city's referral regulations are carried out between designated medical institutions. The referral outside the city is proposed by the designated medical institutions above Grade III in this Municipality.
3. The medical expenses incurred after the insured person is referred to another hospital shall be paid by the individual or unit in cash. After the medical treatment, the insured person or his agent will submit the referral approval form, medical record certificate, prescription and valid documents to the medical insurance agency for reimbursement of hospitalization expenses that fall within the scope of the overall fund payment.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Article 3 The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.
Article 4 Employers and individuals who pay social insurance premiums according to law in People's Republic of China (PRC) have the right to inquire about payment records and personal rights and interests records, and ask social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.
Article 63 If an employer fails to pay social insurance premiums in full and on time, the social insurance premium collection agency shall order it to pay or make up within a time limit. If the employer fails to pay or repay the social insurance premium within the time limit, the social insurance premium collection agency may inquire about its deposit account in banks and other financial institutions; And can apply to the relevant administrative departments at or above the county level to make a decision on the allocation of social insurance premiums, and notify their bank or other financial institutions in writing to allocate social insurance premiums. If the balance of the employer's account is less than the social insurance premium that should be paid, the social insurance premium collection agency may require the employer to provide guarantee and sign a deferred payment agreement. If the employer fails to pay the social insurance premium in full and fails to provide guarantee, the social insurance premium collection agency may apply to the people's court for sealing up, distraining and auctioning the property whose value is equivalent to the social insurance premium that should be paid, so as to offset the social insurance premium with the proceeds from the auction.