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Outpatients’ Direct Medical Expenses Refunding Conducted between Wenzhou and Sahnghai
【Fonts: Large Medium Small 【Source: Wenzhou·China 【Date: 2019.04.23】

From now on, in Wenzhou, the insured personnel covering the Basic Medical Insurance for Urban Employees (BMIUE) can settle the medical expenses of outpatient service with the National Unified Social Security Citizen Card (NUSSCC) in Shanghai in addition to those of hospitalized treatment if they see a doctor there. It is a policy newly released by the Wenzhou Municipal Medical Security Bureau for the convenience of people. Before, the insured had to pay the expenses occurring in Shanghai themselves in advance, and then had them reimbursed in Wenzhou (about 470 km away from shanghai), which is troublesome, and time- and money- consuming. It is learned from the Medical Insurance Center under the Bureau that since the BMIUE was put on the related national network platform in 2017, for the same purpose, the bureau has once released another policy allowing Wenzhou’s personnel covering the same insurance to settle their cross-province hospitalized expenses with NUSSCCs.

23 Medical Institutions in Shanghai Open to CDSOSE

According to the cooperation agreement for the direct settlement of cross-province medical expenses in the Yangtze River Delta, after submitting the related materials for filing, the insured covering the BMIUE can settle their medical expenses of outpatient service with the NUSSC at 23 medical institutions in Shanghai. (Wenzhou is the first city in the country which has conducted this kind of direct settlement in Shanghai.) Meanwhile, starting from April 17, Shanghai's insured personnel can do the same at 19 medical institutions in Wenzhou.

It is learned from a person in charge of the local medical insurance department that at present, the cross-province direct settlement of outpatient service expenses (CDSOSE) has been conducted between Shanghai and a large part of Wenzhou (Lucheng District, Ouhai District, Longwan District, and Economic and Technical Development Zone as well as county-level Ruian City and Yueqing City, the rest parts expected to be included before the end of this year). After going through some formalities for filing at the local social insurance department, this city’s personnel covering the BMIUE, encompassing the migrant retirees, residents and working staff permanently residing in Wenzhou, and the local patients who need cross-province transfer treatment, can carry out the CDSOSE with the NUSSC at the medical institutes in Shanghai open to the CDSOSE. However, it should be noticed that those covering the Basic Medical Insurance for Urban and Rural Residents is not eligible to enjoy the CDSOSE.  

Here is an example to show the troubling cross-province medical expenses reimbursement before the CDSOSE is practiced. Mrs. Wang, a native of Wenzhou, who has covered the BMIUE, permanently lives in Shanghai. Before the CDSOSE is implemented, after seeing a doctor in a hospital in Shanghai, she could not settle the treatment expenses with Wenzhou’ citizen card but with her own money in advance partly for the insurer. To reimburse the expenses, she paid about RMB 500 to buy train tickets and traveled about 470 km and nearly 4 hours to Wenzhou, where bringing with her the evidences, such as related medical treatment records and invoices, she went to the local medicare insurance administration department to have the money refunded. Sometimes, she failed to make reimbursement there owing to incomplete evidences, and had to go to the department once more. Mrs. Wang deeply feels the inconvenience of the past reimbursement procedures. Now, with the CDSOSE implemented, she is so pleased to enjoy easy reimbursement.   

Formalities for Filing Must be Completed before Making CDSOSE

It is necessary to remind the insured personnel that before conducting the CDSOSE, pay attention to doing three matters well: Firstly, complete the formalities for CDSOSE with the medical insurance handling institution; secondly, choose a medical institution designated for CDSOSE in Shanghai; thirdly, carry the NUSSC with you for making the CDSOSE. Otherwise, the direct settlement will be impossible, and even your reimbursing amount be reduced by 25%. In addition, the CDSOSE does not apply to the insured’s special diseases, the cross-province medical treatment expenses of which are settled according to the original procedures. 

Does the CDSOSE have any difference compared to medical treatment and its expenses settlement conducted in Wenzhou? The relevant person in charge of the local medical insurance department gave the answer: the CDSOSE of the local insured personnel who are qualified for CDSOSE, and treated in Shanghai is the same as their being treated and resultant expenses settlement in Wenzhou in the starting point, proportion, and upper limit of medical expenses reimbursement but different in the reimbursement coverage, to which Shanghai’s reimbursement catalogue applies.   

After the CDSOSE is implemented, if the insured personnel fail to make the direct settlement using the NUSSCC at a hospital with the settlement device reporting an error, they should make sure that the formalities for filing have been completed, the hospital is indeed the one designated for the CDSOSE, and the card is in a good condition. If there is nothing wrong, please request the hospital’s medicare office to help contact the related regional medicare handling institution, and ask the institution to solve the problem of failed settlement as soon as possible.

If the settlement is still unsuccessful after its efforts, the insured personnel can settle their medical expenses occurring in other provinces at the place where they bought the insurance. However, the settlement is not based on other province’s medicare catalogue but that of Zhejiang Province. Local citizens can seek related consultation by dialing the phone No. 88863716.

According to statistics, during the trial implementation of the CDSOSE between Wenzhou and Shanghai from April 3 to April 15, this city’s insured personnel made 45 person times of the CDSOSE in shanghai, settling medical expenses amounting to RMB 18,166.9, among which RMB 13,546.85 was paid by the medicare insurance fund; Shanghai’s insured personnel made 9 person times of the CDSOSE in Wenzhou, and RMB 1204.89 of medicare insurance fund was paid by Wenzhou side for Shanghai in advance. According to an analysis of the medical expenses settlement data over the years, it is estimated that in 2019, this city’s over 5,000 urban insured personnel will be free from unpleasant long-distance travel for settling their cross-province medical expenses, and after the insured personnel’s receiving medical treatment, the medical expenses paid by them in advance partly for the insurer will be reduced by RMB 4 million, which will bring convenience to the insured, and also ease the working burden of the local medicare insurance handling institution.

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