Can I be reimbursed after returning to Shanghai? , seek medical treatment if you fall ill while traveling abroad
The long holiday is over. Recently, a reader left a message on the Jiefang Daily·Shangguan News interactive message board asking: "If you get sick and seek medical treatment while traveling overseas, can you be reimbursed after returning to Shanghai?" The reporter contacted the relevant departments and the answer is as follows:
Q: If I participate in employee medical insurance and seek medical treatment for a sudden illness in other places, can I apply for reimbursement after returning to Shanghai?
When an insured person seeks emergency medical treatment in a medical institution in another province or city, the medical expenses will be paid by the employee personally first. Afterwards, the employee can apply for reimbursement of medical expenses that comply with the provisions of basic medical insurance at the medical insurance business service window with relevant information. If employees are able to provide relevant local medical insurance regulations, they can refer to and implement the relevant local regulations, but when applying for sporadic reimbursement, they must not comply with the regulations of two regions at the same time. The insured person should submit an application for sporadic reimbursement of medical expenses within 6 months from the date of receipt issued by the medical institution.
Q: Can medical treatment in other places be settled directly across provinces without going through the reimbursement process?
The National Medical Insurance Administration stipulates that emergency, hospitalization, general outpatient and outpatient chronic disease expenses can be directly settled across provinces. The specific steps are: first register, then select a point, and then use the code card to seek medical treatment.
1. Registration: Before seeking medical treatment in other places across provinces, insured persons can go through the "National Medical Insurance Service Platform APP", "National Medical Treatment Registration Mini Program", "State Council Client Mini Program" or the window of the agency in the insured place, etc. Complete the registration procedures for medical treatment in other places.
2. Selected points: After completing the registration for off-site medical treatment, all inter-provincial networked designated medical institutions opened in the registration area can enjoy inter-provincial direct settlement services for hospitalization expenses; when seeking outpatient medical treatment, you need to first understand the management regulations for off-site medical treatment in the insured place. If the insured place requires the insured to choose a certain number or a designated level of inter-provincial networked designated medical institutions to seek medical treatment and purchase drugs, the regulations of the insured place will be followed.
3. Medical treatment with code card: Valid vouchers such as electronic medical insurance vouchers or social security cards must be presented during admission registration, discharge settlement and outpatient settlement. Inter-provincial networked designated medical institutions provide reasonable and standardized diagnosis and treatment and direct settlement services for medical expenses to outpatients and inpatients who meet the regulations of the place of medical treatment.
At present, all insured persons can register for medical treatment in other places, and emergency rescue personnel are deemed to have registered. People who temporarily go out for medical treatment across provinces can visit the medical place multiple times within the 6-month registration validity period. Please refer to local policies for specific details.
Q: What is the reimbursement ratio for direct settlement of medical treatment in other places?
Answer: When direct settlement is made for medical treatment in another place, which items can be covered by medical insurance shall be subject to the regulations of the place of medical treatment; and the reimbursement ratio and the maximum amount that can be claimed shall be subject to the regulations of the insured place. That is, the medical expenses for inpatient, general outpatient and outpatient chronic diseases that are directly settled in other places shall, in principle, comply with the payment scope and relevant regulations stipulated in the place of medical treatment; while the reimbursement ratio shall comply with the basic medical insurance fund threshold and payment standards stipulated in the insured place. Proportions, maximum payment limits, outpatient chronic disease scope and other relevant policies.
