Notice on Issues Related to Beijing Maternity Insurance Insured Workers Holding Social Security Cards for Medical Treatment and Settlement of Medical Expenses

No.34 [2013] of Beijing Medical Insurance

District and county medical insurance agencies, designated medical institutions and relevant units:

　　In order to facilitate Beijing maternity insurance employees to seek medical treatment and simplify the settlement process, it is decided through research that Beijing maternity insurance employees will be included in the social security card (hereinafter referred to as social security card) medical treatment management system, and relevant issues are hereby notified as follows:

　　First, outpatient medical treatment and settlement

　　Maternity insurance insured workers to carry out prenatal examination and outpatient family planning surgery, the need for full settlement of medical expenses with designated medical institutions, and keep the relevant settlement documents and supporting materials.

　　Maternity insurance employees should submit the relevant settlement documents and supporting materials to the unit where they work. After summarizing the documents that meet the reimbursement policy, the unit will report the expenses to the medical insurance agencies in the districts and counties where the unit is insured in accordance with relevant regulations.

　　Second, hospitalization and settlement

　　(a) maternity insurance employees holding social security cards in hospital, according to the following requirements:

　　1, maternity insurance employees who have issued social security cards should take the initiative to show their social security cards when they are hospitalized. Designated medical institutions with social security cards to check whether maternity insurance insured workers enjoy treatment. For maternity insurance employees who enjoy the benefits, designated medical institutions should use social security cards to complete admission registration on the day of admission. If it is necessary to cancel the admission registration for some reason, the social security card must be used in time.

　　2, maternity insurance insured workers to social security card settlement of medical expenses, designated medical institutions should be to enjoy the treatment of maternity insurance insured workers to advance the medical expenses paid by the maternity insurance fund, to maternity insurance insured workers to collect personal expenses payable, and for maternity insurance insured workers to issue relevant settlement documents.

　　(Failure) 3. Designated medical institutions should upload the settlement data to the maternity insurance information system through the network or offer within 48 hours after completing the settlement.

　　(Invalidation) 4. For the data that have been successfully put into storage, the designated medical institutions can print the Beijing Maternity Insurance Hospitalization Medical Expenses Declaration and Settlement Summary Sheet and other related forms, and report the expenses to the district and county medical insurance agencies to which the designated medical institutions belong within 7 working days from the date of settlement.

　　5, due to the failure of the designated medical institutions information system, resulting in maternity insurance insured workers can not hold the social security card for normal settlement, related expenses to be recovered by the designated medical institutions to re-settle the maternity insurance insured workers.

　　6, maternity insurance insured workers for refund, must hold the social security card and settlement documents to the designated medical institutions for expenses.

　　(two) maternity insurance workers did not send social security cards or social security cards have been lost (damaged), application or replacement of social security cards during hospitalization, according to the following requirements:

　　1, maternity insurance insured workers should hold the "new and fill (change) social security card card certificate" (hereinafter referred to as the "card certificate") in the hospital. Designated medical institutions with the "card certificate" query maternity insurance insured workers enjoy treatment. For the maternity insurance insured workers who enjoy the benefits, the designated medical institutions should use the "Card Certificate" to complete the admission registration on the day of admission. If it is necessary to cancel the admission registration for some reason, it must be handled in a timely manner by using the Certificate of Getting a Card.

　　2, maternity insurance insured workers to the "card certificate" settlement of medical expenses, designated medical institutions should enjoy the treatment of maternity insurance insured workers to advance medical expenses paid by the maternity insurance fund, to maternity insurance insured workers to collect personal expenses, and for maternity insurance insured workers issued relevant settlement documents.

　　3, designated medical institutions should be within 48 hours after the completion of the settlement, through the network or offer to upload the settlement data to the maternity insurance information system.

　　4. For the data that have been successfully put into storage, the designated medical institutions can print the Summary Form of Beijing Maternity Insurance Hospitalization Medical Expenses Declaration and Settlement and other related forms, and report the expenses to the district and county medical insurance agencies to which the designated medical institutions belong within 7 working days from the date of settlement.

　　5, due to the failure of the designated medical institutions information system, resulting in maternity insurance insured workers can not hold the social security card for normal settlement, related expenses to be recovered by the designated medical institutions to re-settle the maternity insurance insured workers.

　　6, maternity insurance insured workers for refund, can hold the social security card or "card certificate" and settlement documents to the designated medical institutions for the expenses incurred.

　　(three) maternity insurance workers without social security card emergency hospitalization, hospitalization in different places, etc., according to the following requirements:

　　1, maternity insurance insured workers due to emergency hospitalization, hospitalization in different places, etc., can not hold social security card real-time settlement, the medical expenses incurred by maternity insurance insured workers and designated medical institutions in full settlement, maternity insurance insured workers should keep the relevant settlement documents and supporting materials.

　　2, maternity insurance employees should submit the relevant settlement documents and proof materials to the unit, the unit will meet the reimbursement policy documents after the summary, in accordance with the relevant provisions to the medical insurance agencies in the insured areas and counties to declare expenses.

　　Three, the county medical insurance agencies audit payment of maternity insurance medical expenses, according to the following requirements:

　　(a) the county medical insurance agencies shall conduct audit and settlement in accordance with the requirements of the maternity insurance medical expenses audit and settlement norms. For the paid medical expenses, the district and county medical insurance agencies should provide various payment details and refusal details for the designated medical institutions and the units where the maternity insurance insured employees work, and print the payment notice, and then transfer it to the social insurance fund management center at the same level with the seal of the district and county agencies.

　　(II) If it is really necessary to recover the paid medical expenses after verification, the county medical insurance agency shall fill out the Notice of Beijing Maternity Insurance Medical Expenses Recovery (in duplicate), one of which is used to inform the recovered unit or individual, and the other is retained by the county medical insurance agency. At the same time, the county medical insurance agencies should input the recovery information into the maternity insurance information system, and transmit it to the social insurance fund management center at the same level together with other medical expense information and payment notice.

　　(III) If it is really necessary to supplement the paid medical expenses after verification, the designated medical institution or the unit where the maternity insurance insured employees work shall fill in the Approval Form for Supplementary Medical Expenses of Beijing Maternity Insurance, and after the examination and approval of the district and county medical insurance agencies, the supplementary information shall be entered into the maternity insurance information system and transmitted to the social insurance fund management center at the same level together with other payable medical expenses information and payment notices.

　　Attachment: 1. Materials to be provided by designated medical institutions for real-time settlement of hospitalization medical expenses with social security card or "Certificate of Receiving Card" for employees participating in maternity insurance.

　　2 designated medical institutions for maternity insurance insured workers full settlement of medical expenses to provide materials.

　　3 designated medical institutions to the medical insurance agencies to declare maternity insurance medical expenses required to provide materials.

　　4 Beijing maternity insurance medical expenses supplement approval form

　　5 units to the medical insurance agencies to declare maternity insurance medical expenses required to provide materials.

　　6 medical insurance agencies to provide materials after the audit settlement of maternity insurance insured workers’ medical expenses.

　　7 Beijing maternity insurance medical expenses recovery notice

Beijing Medical Insurance Affairs Management Center　　　　

December 5, 2013　　

　　(This document is made public upon application)

　　Annex 1

　　Annex 2

　　Annex 3

　　Annex 4

　　Annex 5

　　Annex 6

　　Annex 7