According to the notice recently issued by the Ministry of Human Resources and Social Security and other three departments, starting from April 1, all provinces across the country will pilot the direct settlement of work-related injury insurance for cross-provincial and non-local medical treatment. How does the pilot work? What are the main benefits? How do I apply?
According to the reporter's understanding, the human resources and social security departments of various provinces and the Xinjiang Production and Construction Corps will select less than 40% of the prefectures and cities in their provinces to launch pilot projects. Personnel in need in pilot cities can directly settle the cost of cross-provincial and remote medical treatment, hospitalization work-related injury medical treatment, hospitalization work-related injury** and assistive device configuration in medical institutions with social security cards or electronic social security cards.
This will greatly solve the pain points of work-related injuries such as 'running errands' to reimburse medical expenses and advance funds**. The person in charge of the work-related injury business of a large machinery manufacturing company in Tangshan City, Hebei Province, told reporters that in the past, when workers had major work-related injuries, due to the complexity of the injuries, the injured often needed to go to first-tier cities for treatment. The expenses incurred for medical treatment in other places must be paid in advance by individuals or enterprises, and then reviewed and reimbursed manually with invoices in the later stage, and sometimes it takes nearly a year to arrive. After the implementation of direct settlement, employees can directly go to the work-related injury insurance reimbursement and payment with their social security cards.
By the end of 2023, the number of people insured by China's basic work-related injury insurance exceeded 300 million for the first time, reaching 30.2 billion people, an increase of 10.54 million year-on-year. Carrying out the settlement of medical treatment for work-related injuries in other places will undoubtedly benefit the insured, especially to better protect the rights and interests of employees in industries with relatively high risk of work-related injuries, such as hazardous chemicals, mining, construction, transportation, and machinery manufacturing.
With the enhancement of social mobility, the demand for remote medical treatment for work-related injuries is rising.
In addition to in-service employees, there is also a group of 'old work-related injuries'. They need to live in the long term**, and many of them move to other provinces with their children after retirement. With this policy, it will be more convenient for them to see a doctor. The person in charge of the medical insurance department of a second-class hospital in Shandong said.
So, how will the specific pilot be carried out?
According to the relevant person in charge of the Department of Work-related Injury Insurance of the Ministry of Human Resources and Social Security, the pilot areas will be included in the hospitalization expenses in accordance with the principle of gradual progress, and the long-term residence (work) and referral and transfer personnel in other places will be started in advance, and priority will be given to connecting the areas where medical treatment is concentrated in other places.
The pilot area can determine the number of medical institutions with direct settlement agreements according to the actual situation, and connect one online one. Each province should determine at least one agreement ** institution and one assistive device configuration agency, which can be gradually increased according to the progress situation.
How to apply for it if you need it?
During the pilot period, the personnel seeking medical treatment in other places are limited to those who have lived or worked outside the insured province for more than half a year, as well as the injured employees who need to be referred to a hospital outside the insured province for medical treatment due to medical conditions, and must complete the identification of work-related injury, work-related injury**, work-related injury ** or auxiliary device configuration.
Before seeking medical treatment across provinces and places, the injured employee shall file with the agency in the place of insurance and be reviewed and approved, and the specific procedures can be handled through the national social insurance public service platform, the human resources and social security government service platform, the handheld 12333 APP, the electronic social security card and other national unified service portals, or the window of the agency in the place of insurance.
In order to avoid employees from changing their places of medical treatment too frequently and to guide employees to seek medical treatment in an orderly manner, the notice stipulates that the insured provinces may reasonably set the time limit requirements for employees to change or cancel the filing during the pilot period, but in principle, it shall not exceed 6 months.
There are also many employees who are concerned that the current work-related injury insurance drug catalogue and hospitalization standards in various provinces are different, so after seeking medical treatment in other places, is the treatment enjoyed by work-related injuries according to the standards of the place of insurance or the place of medical treatment?
The relevant person in charge of the Department of Work-related Injury Insurance of the Ministry of Human Resources and Social Security said that the medical expenses for hospitalization work-related injuries and hospitalization work-related injuries shall be subject to the relevant provisions of the work-related injury insurance diagnosis and treatment project catalog, work-related injury insurance drug catalog, work-related injury insurance hospitalization service standards and work-related injury service items at the place of medical treatment; The allocation of assistive devices shall be implemented in accordance with the relevant provisions of the place where the insurance is insured.
In addition, in order to facilitate the flow of personnel, if a long-term resident (work) person in another province or another place seeks medical treatment in another place within the validity period of the record, he or she shall enjoy the work-related injury insurance cost settlement service at the place of medical treatment, and implement the policy of the place of medical treatment; If it is really necessary to return to the insured place and seek medical treatment locally, the work-related injury insurance fee shall be settled according to the standard of the insured place.
The above-mentioned person in charge reminded that direct settlement cannot be achieved for the inpatient meal subsidy and the transportation and accommodation expenses required for medical treatment outside the co-ordination area due to the transfer of hospitals from other places. This part of the expenses needs to be returned to the place of insurance, and the agency will review and reimburse it in accordance with the policy of the place of insurance.