A Letter to Insured Patients Traveling from Out of Town to Seek Medical Treatment in Beijing

Out-of-town patients seeking medical treatment and covered by insurance in Beijing:

Hello. If you are a participant in Beijing's basic medical insurance who has already registered for the direct settlement of inpatient medical expenses incurred while receiving treatment in another province (hereinafter referred to as "direct settlement"), to ensure a smooth and hassle-free experience with direct billing during your stay in Beijing—and to help you avoid unnecessary issues or conflicts—we’d like to remind you of the following important points:

1. Direct settlement is a newly established reimbursement policy and payment method introduced by the state to address issues such as "advance funding, lengthy administrative processes, and extended reimbursement timelines" associated with manual claim submissions for inpatient medical expenses incurred by basic medical insurance participants seeking care in different regions. When you check out from a Beijing-based medical institution designated as a basic medical insurance provider (hereafter referred to as a "designated medical facility") that you’ve personally registered and selected, you can directly settle your current inpatient medical expenses through the National Out-of-Town Medical Settlement System.

2. If you wish to have your inpatient medical expenses directly settled during this visit to Beijing for treatment, you should register and receive inpatient care at the Beijing-based medical institution you’ve pre-registered and selected, following the direct settlement procedure. Direct settlement will only be applicable upon your discharge.

3. The Social Security Card is your sole identification document for direct medical billing in Beijing. When registering for hospitalization or settling discharge accounts, be sure to present it promptly and seek medical care under your real name.

4. If you seek medical treatment and settle your bills directly at a designated medical institution in this city, you must follow the city’s relevant medical treatment procedures and management guidelines. The designated medical institutions in this city will provide you with medical services and manage your care according to the provisions outlined in the "Beijing Basic Medical Insurance Designated Medical Institution Service Agreement."

5. Inpatient medical expenses settled directly at a designated medical institution in this city must fall within the scope of basic medical insurance coverage for this city, adhering to the city’s drug list, clinical treatment programs, and approved medical service facilities—and their corresponding payment standards. Meanwhile, the deductible, reimbursement ratio, and maximum payment limit set by the medical insurance fund will follow the relevant policies of your place of insurance enrollment.

6. When you are discharged from the designated medical institution where you have opted for direct settlement during your inpatient stay, you should, in principle, settle your hospital expenses directly through this method. The designated medical facility will reconcile and pay the portion of costs that you are personally responsible for, based on the results calculated by the system in your insurance region. Meanwhile, any expenses covered by the medical insurance fund will be submitted by the designated medical institution to the local administrative agency in your city for review and settlement. If, for any reason, you need to settle your entire hospital bill yourself, you must inform your insurance provider in advance. Only after switching to full-payment mode can the settlement proceed. Once full payment is made, the relevant expense details will be uploaded by the designated medical institution to the National Interprovincial Medical Settlement System. Subsequently, the portion of the costs reimbursed by the medical insurance fund will be manually processed and paid back to you according to the regulations of your home insurance region.

7. While receiving medical treatment in Beijing, please adhere to Beijing's medical insurance regulations and cooperate with the medical services and treatment management provided by your designated healthcare institution. If any serious violations are detected, the Beijing Medical Insurance Administration and your designated medical facility may suspend your direct settlement privileges as per relevant rules, and will then coordinate with the administrative agency in your insurance enrollment area—through the National Medical Insurance Administration—to handle the matter according to applicable guidelines.

8. As per the national plan, in 2017, local areas were required to gradually roll out direct settlement services across coordinated regions based on the progress of the program. The goal was to move from initial pilot phases to full nationwide coverage within one year. Therefore, before the end of 2017, only insured individuals who had already established direct settlement arrangements with their home regions could enjoy this benefit when seeking medical care in Beijing. In other words, even if you had completed the necessary registration procedures in your home region by the end of 2017, your recent hospitalization expenses incurred during your visit to Beijing would not yet qualify for direct settlement—since your home region hasn’t yet activated the service with Beijing. Instead, you’ll need to cover the full cost upfront and then follow the traditional reimbursement process: submit the claim paperwork to your home region for manual processing and reimbursement according to standard procedures.

9. Since the national inter-provincial medical settlement system platform has just been established, within one year, provinces and cities will need to connect hundreds of sub-systems from various pooled regions through the national platform to enable direct settlement. During this period of system integration and adjustment, occasional technical hiccups may occur, potentially causing inconvenience during your medical billing process. We will actively communicate and coordinate with relevant authorities to address any issues that arise as promptly as possible. Your understanding and support are greatly appreciated. If problems cannot be resolved in a timely manner, you may still choose to pay the full amount upfront for this hospitalization expense and then seek manual reimbursement according to the standard procedures at your place of insurance enrollment.

10. If you have any questions regarding policies on direct settlement, reimbursement procedures for medical treatment, or other related matters, you can call the human resources and social security consultation hotline 12333 in your city or the region where you are insured. Alternatively, you can visit the Ministry of Human Resources and Social Security’s “Social Insurance Online Inquiry System” (website: http//si.12333.gov.cn) to check detailed information on direct settlement policies and regulations, as well as details about coordinated regions and designated medical institutions that currently offer this service. You can also access your personal records, including details on directly settled inpatient medical expenses and registration/filing information.

Beijing's medical insurance administration agencies and designated medical institutions are here to serve you with dedication. Wishing you a smooth and successful medical experience in Beijing!

Beijing Municipal Bureau of Human Resources and Social Security