Notice on issues related to medical treatment and settlement of medical expenses for retired co-ordinators in Beijing with social security cards

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

　　In order to implement the Notice of Beijing Municipality on Overall Planning of Retired Cadres’ Medical Expenses (J.R.S.F. [2010] No.298) and further facilitate retired cadres’ medical treatment, it is decided through research that Beijing retired co-ordinators will be included in the social security card for medical treatment management, and the relevant issues concerning medical treatment and settlement of medical expenses are hereby notified as follows:

　　First, the Beijing social security card (hereinafter referred to as social security card) for medical treatment.

　　Retired co-ordinators need to hold a social security card to go to the designated medical institutions of medical insurance in this city or the designated medical institutions of traditional Chinese medicine, specialties and Class A for medical treatment (except emergency).

　　When the retired co-ordinators go to the designated medical institutions for medical treatment, they must hold the social security card and the Medical Records Manual of Outpatient and Emergency Department of Medical Institutions in Beijing (hereinafter referred to as the Medical Records Manual), and take the initiative to show it.

　　(a) retired co-ordinators with social security Carmen (emergency) medical treatment, according to the following requirements:

　　1, retired co-ordinators should hold social security card registration, medical expenses paid by designated medical institutions, registration fees borne by the individual. Designated medical institutions provide special bills for registration fees for retired co-ordinators

　　2. When the retired co-ordinators seek medical treatment, they should take the initiative to show their social security cards, and doctors in designated medical institutions should check and write the Medical Record Manual according to the regulations on health administration for disposal.

　　3. When the retired co-ordinator holds a social security card to settle the medical expenses, the designated medical institution shall issue settlement documents for the retired co-ordinator to advance the medical expenses paid by the retired co-ordinator fund, and the remaining expenses shall be paid by the retired co-ordinator.

　　(Invalidation) 4. Designated medical institutions should designate special personnel to be responsible for data uploading and warehousing review, and upload the settlement data to the medical insurance information system through the network or offer within 48 hours after the settlement is completed.

　　(Failure) 5. For the data that have been successfully put into storage, the designated medical institutions can print the declaration form for the medical expenses of the retired personnel’s outpatient (emergency) consultation, and report the expenses to the district/county medical insurance agency (hereinafter referred to as the district/county agency) to which the designated medical institutions belong.

　　6. If the retired co-ordinator needs to be referred for treatment due to illness, the doctor of the designated medical institution will issue the Beijing Medical Insurance Referral (Hospital) Sheet, and the medical insurance office of the designated medical institution must use the social security card of the retired co-ordinator to handle the referral procedures.

　　After the retired co-ordinators go through the referral procedures, the medical expenses incurred in transferring to designated medical institutions can be settled according to the relevant provisions of the retired co-ordinators.

　　7. Due to the failure of the information system of designated medical institutions, the retired co-ordinators can’t settle their accounts normally with social security cards. After the system is restored, the designated medical institutions will re-handle the expenses settlement for the retired co-ordinators.

　　8. If the retired co-ordinator needs a refund, he/she shall go to the designated medical institution where the expenses occur with the social security card and settlement documents.

　　(two) retired co-ordinators to social security card hospitalization, according to the following requirements:

　　1. When a retired co-ordinator holds a social security card for hospitalization for the first time, the Handbook for Retired Cadres in Beijing will be automatically invalidated. Designated medical institutions must use social security cards to register the retired co-ordinators on the day of admission, and keep the social security cards of the retired co-ordinators.

　　2. When the retired co-ordinator settles the medical expenses, the designated medical institutions shall issue settlement documents for the retired co-ordinator to advance the medical expenses paid by the retired co-ordinator fund, and the remaining expenses shall be paid by the retired co-ordinator. At the same time, the designated medical institutions should return the social security card to the retired coordinator.

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

　　4. After the designated medical institutions upload the settlement data, they can print the hospitalization expense declaration and settlement list and other related forms, and report the expenses to the district/county agencies affiliated to the designated medical institutions with relevant materials as required.

　　5, designated medical institutions to use social security card for retired co-ordinators for admission registration, for some reason need to cancel the admission registration, must use social security card.

　　6. If the retired co-ordinator needs to be transferred for treatment due to illness, the doctor of the designated medical institution shall issue the Beijing Medical Insurance Referral (Hospital) Form and handle the transfer procedures.

　　After the retired co-ordinators go through the transfer procedures, the medical expenses incurred in transferring to designated medical institutions can be settled according to the relevant provisions of the retired co-ordinators.

　　7. If the retired co-ordinator needs a refund, he/she shall go to the designated medical institution where the expenses occur with the social security card and settlement documents.

　　Two, retired personnel lost (damaged) social security card, apply for a replacement (replacement) card during medical treatment, according to the following requirements:

　　(1) During the period when retired co-ordinators who have issued social security cards apply for replacement cards, when they go to designated medical institutions for medical treatment, they need to take the initiative to produce the Certificate of Getting a New and Replacement Social Security Card, and the medical expenses incurred shall be fully settled by retired co-ordinators and designated medical institutions. Designated medical institutions should collect relevant information and upload the details of medical expenses according to the Certificate of Getting a New Social Security Card, and issue relevant documents for retired co-ordinators.

　　(2) After the retired co-ordinator and the designated medical institution have settled the medical expenses in full, they shall submit the expense details, prescriptions, original receipts and relevant certificates to their units. After the summary of the unit, fill in the Summary Form for Manual Reimbursement of Medical Expenses for Outpatient (Emergency) Clinic of Retired Co-ordinators in Beijing, the Summary Form for Manual Reimbursement of Hospitalization Medical Expenses for Retired Co-ordinators in Beijing and the Declaration Form for Manual Reimbursement of Medical Expenses for Retired Co-ordinators in Beijing (in duplicate), and report to the district and county agency where the unit is located on the 1st to 20th of each month.

　　Three, has not yet issued a social security card for retired personnel, according to the following requirements:

　　(a) outpatient medical treatment

　　1. When the retired co-ordinator who holds the Manual for Medical Treatment of Retired Cadres in Beijing goes to the outpatient clinic for medical treatment, the medical expenses incurred shall be fully settled by the retired co-ordinator and the designated medical institution. Designated medical institutions should collect relevant information and upload the details of medical expenses according to the Handbook for Retired Cadres in Beijing, and issue relevant documents for retired co-ordinators.

　　2. When newly participating in the retired cadres’ outpatient service without the Beijing Retired Cadres’ Manual for Medical Treatment, they need to take the initiative to show the Certificate of Getting a New and Supplementary Social Security Card, and the medical expenses incurred will be fully settled by the retired co-ordinators and designated medical institutions. Designated medical institutions should collect relevant information and upload the details of medical expenses according to the Certificate of Getting a New Social Security Card, and issue relevant documents for retired co-ordinators.

　　3. After the retired co-ordinator and the designated medical institution have settled the medical expenses in full, they shall submit the expense details, prescriptions, original receipts and relevant certificates to their units. After the summary of the unit, fill in the Summary Form for Manual Reimbursement of Medical Expenses for Outpatient (Emergency) Consultation of Retired Co-ordinators in Beijing and the Declaration Form for Manual Reimbursement of Medical Expenses for Retired Co-ordinators in Beijing (in duplicate), and report to the district and county agency where the unit is located on the 1st to 20th of each month.

　　(2) Hospitalization

　　1. When the retired co-ordinator who holds the Beijing Retired Cadres Medical Manual is hospitalized, the retired co-ordinator should take the initiative to show the Beijing Retired Cadres Medical Manual when registering for admission, and the designated medical institutions should register for admission according to the Beijing Retired Cadres Medical Manual and keep the Beijing Retired Cadres Medical Manual. When the retired co-ordinators settle medical expenses, the designated medical institutions shall issue settlement documents for the retired co-ordinators to advance the medical expenses paid by the retired co-ordinators fund, and the remaining expenses shall be paid by the retired co-ordinators. At the same time, the designated medical institutions should return the Handbook for Retired Cadres in Beijing to the retired co-ordinators.

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

　　3. After the designated medical institutions upload the settlement data, they can print the hospitalization expense declaration and settlement list and other related forms, and report the expenses to the district/county agencies affiliated to the designated medical institutions with relevant materials as required.

　　4. When the retired cadres who are newly involved in the overall planning for retirement and have no Manual for Medical Treatment of Retired Cadres in Beijing are hospitalized, they need to take the initiative to show the Certificate of Getting a New and Supplementary Social Security Card, and the medical expenses incurred will be fully settled by the retired overall planning personnel and the designated medical institutions. Designated medical institutions should collect relevant information and upload the details of medical expenses according to the Certificate of Getting a New Social Security Card, and issue relevant documents for retired co-ordinators.

　　5. After the retired co-ordinator and the designated medical institution have settled the medical expenses in full, they should submit the expense details, prescriptions, original receipts and relevant certificates to their units. After the unit summarizes, fill in the Summary Form of Manual Reimbursement of Hospitalization Medical Expenses of Retired Co-ordinators in Beijing and the Declaration Form of Manual Reimbursement of Medical Expenses of Retired Co-ordinators in Beijing (in duplicate), and report to the district and county agencies where the unit is located on the 1st to 20th of each month.

　　Four, retired personnel in different places for medical treatment, according to the following requirements:

　　(a) retired co-ordinators should go to designated medical institutions (except emergency) selected by individuals for medical treatment in different places, and the medical expenses incurred should be fully settled by retired co-ordinators and designated medical institutions, and the designated medical institutions should issue relevant documents for retired co-ordinators.

　　Five, the county agency audit payment of retired personnel medical expenses, according to the following requirements:

　　(a) the county agencies should set up special personnel to be responsible for receiving the expense settlement documents and related materials submitted by designated medical institutions and retired co-ordinating personnel units, and check them with the medical insurance information system, and return the application materials if the submitted materials are incomplete or the information is inconsistent.

　　(II) The district and county agencies shall designate special personnel to be responsible for the preliminary examination, review and external audit of medical expenses, and communicate with the designated medical institutions in time for the medical expenses in question, and the medical expenses that need further verification can be paid in advance, and external auditors shall be sent for verification, and those that do not meet the requirements shall be recovered.

　　For the outpatient (emergency) expenses declared by designated medical institutions, the district and county agencies need to print the real-time settlement outpatient expenses audit form after completing the audit. For the medical expenses declared by the retired co-ordinator unit, the district and county agencies need to print the approval form for manual reimbursement after completing the audit.

　　(three) the county agencies should be responsible for the settlement and payment of medical expenses. For the paid medical expenses, the district and county agencies should provide various payment details and refusal details for the designated medical institutions and employers, print the payment notice at the same time, and affix the seal of the district and county agencies to the social insurance fund management center at the same level.

　　Six, the implementation of this notice since January 1, 2011.

　　Attachment:

　　1. Designated medical institutions need to provide materials for the real-time settlement of medical expenses of retired co-ordinators with social security cards.

　　2. The designated medical institutions shall provide materials for the full settlement of medical expenses by retired co-ordinators

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

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

　　5 medical insurance agencies need to provide materials after the audit settlement of medical expenses of retired co-ordinators

Beijing Medical Insurance Affairs Management Center

December 24th, 2010