National Cross-Provincial Medical Insurance Settlement System Completed: Hospitals Across Provinces Now Accessible for Direct Billing

Recently, the Ministry of Human Resources and Social Security released the first batch of regions and designated medical institutions for the direct settlement of inpatient medical expenses under basic medical insurance for cross-provincial healthcare services outside one’s home province, gradually facilitating access to medical care across different regions.

At the end of last December, the Ministry of Human Resources and Social Security revealed that China would achieve nationwide networking of basic medical insurance in 2017, enabling direct settlement of hospitalization expenses for retirees resettled across provincial boundaries. In 2017, priority will be given to resolving the direct settlement of hospitalization costs for such cross-provincial resettled retirees, with coverage expanded by year-end to include direct settlement of hospitalization expenses for patients seeking medical care outside their home province in accordance with referral regulations.

In accordance with the nationwide implementation schedule, currently only retirees resettled in other regions are eligible. Moving forward, in conjunction with reforms to the household registration (hukou) and residence permit systems, individuals residing long-term in other regions, personnel stationed long-term in other regions, and patients referred or transferred to hospitals in other regions in compliance with regulations will be gradually included in the coverage of direct settlement for inpatient medical expenses incurred outside their home regions.

Retirees must register and file with the medical insurance agency in their place of insurance coverage and undergo a social security card verification before seeking cross-provincial out-of-area medical care. Once the insured person’s region of insurance affiliation has enabled this service, they shall, in accordance with local regulations, register and file with the local social insurance agency prior to receiving cross-provincial out-of-area medical care. After the agency uploads the registration information to the National Basic Medical Insurance Out-of-Area Medical Care Settlement System, the insured may use their Social Security Card for direct settlement of inpatient medical expenses at designated medical institutions that have been authorized for such services.

Insured individuals may log in to http://si.12333.gov.cn to query in real time the latest information on regional coverage and the status of designated medical institutions. When completing registration procedures, they must first select a hospital for treatment from among the published list of medical institutions offering direct settlement services in the place of care. In principle, only one hospital may be selected from each tier: primary (Tier I), secondary (Tier II), and tertiary (Tier III) hospitals.

When necessary, the insured individual must present their social security card at the designated hospital for inpatient treatment. Upon discharge, the card will be swiped directly for settlement, with personal payment and medical insurance reimbursement processed simultaneously.

Insured individuals are reminded to promptly contact the social security bureau of their district or county in the place of insurance registration to supplement and complete their filing information, so as to avoid any disruption to real-time settlement for cross-province medical treatment after the integration of the original inter-provincial settlement system with the national settlement system.

Before seeking medical treatment in a different region, insured individuals must register and file records in accordance with the regulations of the local medical insurance agency. By presenting their social security card at the designated hospital for inpatient care, they can settle the bill directly by swiping the card upon discharge, thereby simultaneously completing the personal payment settlement and medical insurance reimbursement.

As of May 12 this year, all provinces in China, except for Tibet, Inner Mongolia, and Shanghai, have fully or partially integrated into the National Basic Medical Insurance System for Cross-Regional Medical Expense Settlement. A total of 160 regions and 1,041 designated medical institutions have been enabled for direct settlement of inpatient medical expenses incurred during cross-provincial healthcare visits.

Based on the published list, Xinjiang has the highest number of hospitals enrolled in the inter-provincial medical expense settlement program, with 312 hospitals selected. In contrast, provinces such as Fujian, Zhejiang, Henan, Guangdong, Qinghai, and Hunan each have fewer than 10 participating hospitals.

A total of 19 designated medical institutions in Beijing have been included in the list, including Peking University People's Hospital, General Hospital of the Chinese People's Liberation Army (formerly known as the Army General Hospital), Beijing Chaoyang Hospital, Beijing Shijitan Hospital, Peking Union Medical College Hospital, Beijing Tongren Hospital, Beijing Tiantan Hospital, Beijing Hospital, Fuwai Hospital, Peking University First Hospital, Beijing Jishuitan Hospital, Xuanwu Hospital, Cancer Hospital Chinese Academy of Medical Sciences, Beijing Anzhen Hospital, China-Japan Friendship Hospital, Chinese PLA General Hospital, Peking University Third Hospital, Peking University Cancer Hospital, and Beijing Friendship Hospital.

Chongqing, where VCBeat is based, has 11 hospitals, including the First Affiliated Hospital of Chongqing Medical University, the Second Affiliated Hospital of Chongqing Medical University, Southwest Hospital, the Second Affiliated Hospital of the Third Military Medical University, Daping Hospital, Chongqing Traditional Chinese Medicine Hospital, Chongqing Cancer Hospital, the Stomatological Hospital of Chongqing Medical University, the University Town Hospital of Chongqing Medical University, the Yongchuan Hospital of Chongqing Medical University, and the Children’s Hospital of Chongqing Medical University.