I. Filing for Record: The "Passport" for Off-site Medical Treatment
1. Long-term Off-site Residence Filing
Applicable to retirees settling with children, long-term off-site workers and other similar groups. The filing remains permanently valid upon completion, allowing dual access to medical benefits in both the filed location and the participant’s insurance enrollment region.
2. Temporary Off-site Medical Treatment Filing
For short-distance business trips, travel and other temporary scenarios. The filing is valid for 6 months uniformly. Multiple medical visits and direct settlement are available within the validity period without repeated filing.
3. Key Notes on Filing
- Complete filing in advance following the principle of File First, Settle Later. While supplementary filing before discharge is permitted in some regions, it is recommended to set the filing start date 2–3 days prior to treatment instead of the exact treatment day, to avoid failed medical insurance settlement.
- Update filing information promptly if the designated treatment location changes after filing.
- Emergency patients receiving off-site emergency rescue shall be deemed filed without prior formalities, but relevant emergency certificates shall be retained.
Recommended online filing channels for high efficiency and convenience:
1. National Medical Insurance Service Platform APP
2. Mini Program for National Off-site Medical Filing
3. State Council Client Mini Program
4. Local medical insurance mini programs of some regions
Starting from 2025, filing materials have been greatly simplified. Core documents include the medical insurance electronic certificate, valid identity document or social security card, and filing form. Notably, many regions adopt the commitment-based filing system: long-term off-site residents may complete filing by signing a commitment letter first and supplement supporting documents (such as residence permits) afterwards, subject to local time limits for supplementary materials.
II. Medical Treatment: Direct Settlement at Designated Hospitals After Filing
1. Present the medical insurance electronic certificate, ID card or social security card during registration, then consult a physician.
2. Settle medical fees at the billing counter after consultation; the system automatically calculates the reimbursable amount and self-paid amount.
3. Only pay the personal share without full advance payment of total medical expenses.
Special Reminder: If registration is completed at personal expense without presenting medical insurance credentials, inform the attending physician of medical insurance coverage, and ask the physician to guide re-registration with medical insurance at the triage desk before consultation; otherwise, reimbursement will be affected!
Supplementary Notes
The core principle for settlement of off-site outpatient (and inpatient) medical insurance expenses is Directory of Treatment Region, Policies of Enrollment Region:
- The scope of reimbursable items follows the medical insurance directory of the treatment location (medicines, medical services, medical consumables, etc.).
- Reimbursement ratios, deductibles, maximum annual payment caps and other rules comply with policies of the participant’s insurance enrollment region. This rule avoids reimbursement disputes arising from regional directory discrepancies.
A small number of provinces and municipalities adopt the directory of the enrollment region for settlement; the final reimbursement rules shall be subject to the off-site medical insurance policies of the enrollment region.
Off-site outpatient medical insurance involves multiple links including filing, designated hospital selection and settlement. Participants are advised to learn relevant policies of their enrollment region in advance to prevent unsuccessful reimbursement or lower-than-expected reimbursement ratios.