About Medical Insurance
1. Guangzhou has now enabled direct settlement for hospitalization, general outpatient visits, and specified outpatient diseases for cross-region medical treatment within Guangdong Province, as well as direct settlement for hospitalization and general outpatient expenses for inter-provincial medical treatment. Guangzhou insured persons who have completed filing for cross-region medical treatment may directly settle the relevant medical expenses after receiving care.
2. For insured persons who have completed filing, general outpatient visits for cross-region medical treatment are not subject to designated-facility restrictions. For specified outpatient diseases, the corresponding entitlement confirmation procedures should be completed in advance. For some specified outpatient diseases that require selection of one treatment medical institution, insured persons should complete the facility selection or change procedures when filing, or after filing but before seeking care. For details, please refer to the Guangdong Government Services Network item “Recognition of Basic Medical Insurance Insured Persons’ Entitlement to Specified Outpatient Disease Benefits | Change of Designated Medical Institution for Specified Outpatient Diseases for Medical Insurance Insured Persons.”
Website: http://www.gdzwfw.gov.cn/portal/guide/11440100MB2C90741H344218921100102
3. Insured persons entitled to Category I and Category II specified outpatient disease benefits, hereinafter referred to as “specified outpatient disease” benefits, must complete the required entitlement confirmation procedures. For specified outpatient diseases that require facility selection, a qualified connected medical institution at the filing location should be selected as the designated treatment institution in accordance with regulations.
Important Notes
For cross-region medical treatment within Guangdong Province, the 52 disease categories under the province-wide unified scope, shown in the image at the end of this article, may be directly settled for cross-region care. The 15 disease categories specific to Guangzhou cannot currently be directly settled and must still be reimbursed according to the original procedures. For inter-provincial medical treatment, disease categories eligible for direct settlement will be announced separately by the province. Before unified deployment by the provincial authority, direct settlement for inter-provincial specified outpatient disease treatment cannot be implemented.
4. If insured persons have not yet prepared all materials required for long-term cross-region medical treatment filing, they may first apply for temporary cross-region medical treatment filing by submitting a personal commitment and other required materials as needed.
5. For insured persons who have completed cross-region medical treatment filing, eligible medical expenses incurred at connected medical institutions within the administrative area of the city where they seek care, or within the corresponding province for Beijing, Tianjin, Shanghai, Chongqing, Hainan, Tibet, and the Xinjiang Production and Construction Corps, and that are connected with Guangzhou’s social medical insurance system, may be directly settled online. There is no need to separately apply for reimbursement of scattered medical expenses. If an insured person seeking cross-region medical treatment genuinely needs to receive care at a non-connected medical institution outside Guangzhou, a commitment letter must be issued explaining the reason and specifying the selected hospital that does not support connected settlement.
6. The list of connected medical institutions can be searched on the portal website of the Guangzhou Municipal Medical Insurance Bureau: log in to http://www.gz.gov.cn/zfjg/gzsylbzj/ybfw/index_2.html and check the “List of Designated Medical Institutions for Direct Settlement of Inter-Provincial Cross-Region Medical Treatment for Guangzhou Insured Persons” and the “List of Connected Medical Institutions for Intra-Provincial Cross-Region Medical Treatment for Guangzhou Social Medical Insurance Insured Persons.”
7. After completing long-term cross-region medical treatment filing, the cross-region medical treatment benefits for retirees resettled outside Guangzhou and non-employed insured persons living long-term outside Guangzhou remain valid long-term. For employed insured persons living long-term outside Guangzhou, the validity period of cross-region medical treatment benefits should be reasonably determined based on the duration of residence, work, or study outside Guangzhou, and in principle should not exceed five years. The validity period for filing for cross-region emergency treatment, student cross-region medical treatment, cross-region referral, or temporary cross-region medical treatment is six months.
8. After cross-region medical treatment benefits take effect, insured persons who complete temporary cross-region medical treatment filing may still enjoy medical insurance benefits for hospitalization, specified outpatient diseases, and general outpatient visits at designated medical institutions within Guangzhou. Insured persons who complete long-term cross-region medical treatment filing will no longer continue to enjoy hospitalization and specified outpatient disease benefits at designated medical institutions within Guangzhou, and from the month after completion of the filing will no longer continue to enjoy general outpatient medical insurance benefits.
9. During the COVID-19 pneumonia epidemic, insured persons who need hospitalization for illness at a connected medical institution outside Guangzhou that supports direct settlement may temporarily complete filing under this item.
Finally
It is time for Q&A.
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Has Guangzhou launched direct settlement of outpatient expenses for cross-region medical treatment?
Yes. Based on the progress of medical insurance work in Guangdong Province, Guangzhou has now enabled direct settlement for general outpatient expenses and specified outpatient diseases within the province, as well as inter-provincial general outpatient expenses. Insured persons from regions where outpatient settlement services have been launched who come to Guangzhou for medical treatment, and Guangzhou insured persons who seek care in regions where outpatient settlement services have been launched, may settle eligible outpatient expenses through the connected settlement system.
Under what circumstances can cross-region medical treatment be used, such as long-term cross-region medical treatment, student cross-region medical treatment, cross-region referral, or temporary cross-region medical treatment?
First, for Guangzhou insured persons, direct settlement of outpatient expenses for cross-region medical treatment can be used after completing cross-region medical treatment filing procedures, including all types of cross-region medical treatment filing.
Second, for insured persons from other regions, the relevant procedures must be completed according to the requirements of the place of insurance enrollment before they can enjoy direct settlement of outpatient expenses for cross-region medical treatment. For specific procedures, please consult the medical insurance administrative agency at the place of insurance enrollment.
After direct settlement for general outpatient visits within and across provinces is launched, how should the lump-sum benefit be handled for insured persons who have already completed or are preparing to complete long-term cross-region medical treatment filing?
For employee medical insurance participants who have completed long-term cross-region medical treatment filing, because general outpatient pooling benefits have already been paid in a lump-sum manner, the general outpatient expenses incurred cannot be directly settled. If direct settlement for cross-region general outpatient visits is needed, they may submit a commitment letter when applying for long-term cross-region medical treatment filing to change the method for receiving general outpatient benefits, or later complete the change online through the “business change” handling item under the corresponding “cross-region medical treatment filing” service on the Guangdong Government Services Network. After the direct settlement service for general outpatient visits is activated, general outpatient pooling benefits will no longer be paid in a lump-sum manner.
Which specified outpatient disease categories are eligible for direct settlement in cross-region medical treatment?
For cross-region medical treatment within Guangdong Province, the specified outpatient disease categories eligible for direct settlement are the 52 province-wide unified disease categories shown below.
For inter-provincial medical treatment, the specified outpatient disease categories eligible for direct settlement will be announced separately by the province. Before unified deployment by the provincial authority, direct settlement for inter-provincial specified outpatient disease treatment cannot be implemented.
Members of the public may follow the “Guangzhou Medical Insurance” WeChat official account for the latest updates.
Scope of Specified Outpatient Diseases under Guangdong Province Basic Medical Insurance
(Click to view the enlarged image)
That concludes today’s overview of cross-region medical treatment filing.
If you need to learn more,
you can use the “Social Security and Medical Insurance Policy Inquiry Assistant.”
