昌平医保：异地就医备案与门诊报销

Changping yibao: off-site medical treatment filing and outpatient reimbursement

北部科教新城 · 明十三陵与居庸关长城所在地 · 昌平线贯穿南北。医保备案是异地看病能不能直接刷医保卡的前提，异地就医备案与门诊报销这一步在 昌平 线上几分钟就能完成，但材料、时限、报销比例有明确口径。下面把承办机构、窗口、条件和流程写清楚。

Beibu Kejiao Xincheng · Home to the Ming Tombs and Juyongguan Great Wall · The Changping Line runs through the area from north to south. Medical insurance filing is the prerequisite for directly swiping your insurance card when seeking treatment elsewhere. The cross-regional medical insurance registration and outpatient reimbursement step can be completed in just a few minutes on the Changping Line, but the required materials, time limits, and reimbursement ratios all have clear and specific guidelines. Below is a detailed breakdown of the responsible agencies, service windows, eligibility conditions, and procedures.

一、先说结论：异地就医备案与门诊报销怎么办

1. Bottom line first: how to handle cross-region medical treatment registration and outpatient reimbursement

一句话结论：异地就医备案已经可以全程线上办，在国家医保服务平台 App、电子医保卡或「京通」里提交后即时生效，不需要到窗口；门诊报销则看是不是在定点医疗机构——在定点直接刷医保卡结算，不在定点要自己垫付再回来报。{cn} 医保经办窗口在东环路 93 号院 1 号楼，异地备案成功后建议先打电话确认备案参保地显示正确。

Bottom line: cross-region medical treatment registration can now be done entirely online—submit it in the National Healthcare Security Administration app or via the electronic medical insurance certificate, and it takes effect immediately without visiting a window. For outpatient reimbursement, it depends on whether you are at a designated medical institution: at a designated hospital you swipe the medical insurance card directly at settlement; at a non-designated one you pay upfront and claim reimbursement later. {cn} The medical insurance service window is at 1 Lou, Yuan 93, Donghuan Lu; after your cross-region registration succeeds, call first to confirm the insured-location display is correct.

医保异地就医最常见的两类失败，都不是政策问题。一是备案参保地填错：很多人以为「参保地」要填成要去的地方，实际应填你的参保地医保经办机构；二是备案后仍用旧的实体卡结算，如果卡状态异常或未激活，联网结算会失败，正确做法是直接用医保电子凭证。第二类失败的解法都是十秒钟能做完的动作，却经常拖成一次往返。

The two most common failures when using medical insurance across regions are not policy problems. First, filling in the wrong insured location on the registration form: many people assume the 'insured location' should be wherever they are going to seek care, but it should actually be the medical insurance handling agency at their home insured location. Second, still using the old physical card after registration—if the card status is abnormal or unactivated, network settlement will fail; the correct fix is to use the electronic medical insurance certificate instead. The fix for both failures is a ten-second action that is often dragged into a full round trip.

还有一点要提醒：{cn} 的医保经办窗口和社保办事大厅都在东环路 93 号片区，但医保在 1 号楼、社保在 93 号院，两处不是同一入口。同时办理两件事时可以一趟走完，但要预留出中间的排队时间，并分别取号。窗口办公时间以当日公示为准，遇到上午集中办理的高峰时，下午去通常更快。

One more thing to note: {cn} the medical insurance service window and the social-security service hall are both in the Donghuan Lu 93 area, but the medical insurance office is in 1 Lou while social security is at Yuan 93—they are not the same entrance. If you are handling both matters in one trip, you can walk it off in one go, but allow time for the queue between them and collect a number at each window separately. The window office hours are subject to the day's posted notice; if the morning sees a concentrated rush, heading over in the afternoon is usually faster.

二、谁来办，电话怎么打

II. Who Handles It and How to Call

区分两个口径很重要：医保局负责政策、备案、待遇和基金的业务口径，医保经办服务窗口是具体办事的地方。打医保局电话问「我能不能报」这种政策问题；打窗口电话问「我今天能不能办、要不要预约」。表中标「官方」的号码来自政府网站公示，可直接拨打。

It is important to distinguish two types of inquiries: the Medical Insurance Bureau handles policy, registration, benefits, and fund matters, while the Medical Insurance Service Window is the physical location where business is conducted. Call the bureau to ask policy questions like 'Can I get reimbursed?'; call the window to ask about walk-in availability or whether an appointment is needed. Numbers marked as 'official' in the table are from government website listings and can be dialed directly.

三、去哪个窗口办，几点开门

3. Which window to go to and when it opens

{cn} 医保经办窗口在东环路 93 号院 1 号楼，与社保办事大厅同片区但不是同一个大厅，别走错门。窗口业务由不同岗位分办，建议出发前先打咨询电话确认在岗，尤其是备案信息更正、门诊慢特病待遇认定这类需要查系统的业务。

{cn} Medical Insurance Service Window is located at Building 1, Courtyard 93, Donghuan Road. It shares the same complex with the social security service hall but is not the same hall — do not go to the wrong door. Services are handled by different positions at the window, so it is recommended to call ahead to confirm who is on duty, especially for business involving system lookups such as registration information corrections or outpatient chronic/special disease benefit determinations.

四、谁能办（受理条件）

4. Who Can Apply (Eligibility Requirements)

先对照下面几条确认自己符合，再去窗口，能省掉一次白跑。条件以官方办事指南原文为准。

Check the following conditions first to confirm eligibility before heading to the window, saving an unnecessary trip. Conditions are subject to the official guide text.

• 已在 {cn} 参保、参加职工医保或城乡居民医保的人员，都可以办理异地就医备案。
• 跨省异地就医（含住院、门诊与门诊特殊病）需办理跨省异地就医备案；本市范围内跨区就医按 {cn} 医保部门的具体要求执行。
• 办理备案需要人在异地就医之前完成，备案后就医的才适用；已经看完病再补备案的，一般按政策规定处理，不建议依赖事后补办。
• 异地长期居住人员与临时外出就医人员的备案有效期和取消规则不同，长期居住备案可多次使用，临时外出备案按就医批次失效。
• 参保人当前为正常参保状态（未终止、未享受失业保险待遇等中止状态）才能正常享受异地直接结算。
• 门诊特殊病病种待遇的认定与备案是两件事：备案解决「能不能在异地刷」，病种认定解决「按什么比例报」，两者都要办。
• Individuals who are already enrolled in medical insurance in {cn}, whether participating in the employee medical insurance scheme or the urban-rural resident medical insurance scheme, can apply for out-of-province medical treatment registration.
• Cross-province out-of-area medical treatment (including hospitalization, outpatient visits, and outpatient special diseases) requires filing a cross-province out-of-area medical treatment registration; for medical treatment across districts within the city, follow the specific requirements of the {cn} medical insurance department.
• Registration must be completed before seeking medical treatment in another location, and only medical treatment taken after registration is eligible. Retroactively filing after completing treatment is generally handled according to policy provisions and is not recommended — do not rely on post-filing.
• The filing validity periods and cancellation rules differ for long-term residents in other locations versus temporary out-of-town medical visitors; long-term residence filings can be used multiple times, while temporary medical visit filings expire by each treatment batch.
• The insured must currently be in an active insurance status (not terminated, not suspended due to unemployment insurance benefits, etc.) to normally enjoy direct cross-regional settlement.
• Recognition and filing of outpatient special disease benefits are two separate matters: filing addresses 'whether you can use it out of town', and disease recognition addresses 'at what reimbursement ratio'; both must be completed.

五、带什么材料

V. What Materials to Bring

材料一次带齐是办事效率的关键。下面按「原件 / 复印件 / 需现场填写」分开列，缺一项就可能被退回补正。

Bringing all required materials at once is key to processing efficiency. Below they are listed separately by 「original / copy / to be filled out on site」— missing any item may result in a return for supplementary documents.

• 备案本身线上办理，不需要纸质材料；线上提交需要本人实名认证与手机号绑定。
• 代办备案的，需提供委托书与双方身份证件；线上代办按所选平台的授权流程操作。
• 非本人手机操作备案的，需按平台要求完成亲属关系或代办授权认证，否则会提示不符合条件。
• 门诊报销（非直接结算）需提供：门诊收费票据原件、费用清单（明细）、本人身份证件、医保卡或电子医保卡凭证。
• 住院费用报销另需提供：出院小结（出院记录）、住院费用总清单、诊断证明（如有）、医疗机构收费票据。
• 门诊特殊病种报销需提供病种认定材料（如既往病历、诊断证明）与当次结算单据，具体以医保经办要求为准。
• 委托他人代为报销的，另需提供委托书、委托人身份证件复印件与被委托人身份证件原件。
• 所有票据原件请勿提前丢失，异地报销的票据复核周期可能较长，建议先自行留存清晰复印件或照片备查。
• Filing is handled online without paper documents; online submission requires personal real-name authentication and a linked mobile phone number.
• For proxy filing, a power of attorney and ID documents for both parties are required; online proxy filing follows the authorization process of the selected platform.
• If filing is operated on someone else's phone, relative relationship or proxy authorization certification must be completed per the platform's requirements, otherwise it will show as ineligible.
• For outpatient reimbursement (non-direct settlement), the following are required: original outpatient fee receipts, itemized cost statement, the insured's ID document, medical insurance card or electronic medical insurance certificate.
• For inpatient expense reimbursement, additionally provide: discharge summary (discharge record), total inpatient cost statement, diagnostic certificate (if applicable), and the medical institution's fee receipt.
• For reimbursement of outpatient special diseases, certification materials for the disease (e.g., past medical records, diagnosis certificates) and settlement receipts from the current visit are required. Specific requirements are subject to those of the medical insurance agency.
• When entrusting another person to submit the reimbursement on your behalf, additionally provide a power of attorney, a copy of the entrusting party's ID document, and the original ID document of the authorized representative.
• Please do not lose any original receipts in advance. Reimbursement receipts filed out of province may take longer to verify. It is recommended to keep clear photocopies or photos for your own records in case they are needed later.

医保异地就医最常见的两类失败，都不是政策问题。一是备案参保地填错：很多人以为「参保地」要填成要去的地方，实际应填你的参保地医保经办机构；二是备案后仍用旧的实体卡结算，如果卡状态异常或未激活，联网结算会失败，正确做法是直接用医保电子凭证。第二类失败的解法都是十秒钟能做完的动作，却经常拖成一次往返。

The two most common failures when using medical insurance across regions are not policy problems. First, filling in the wrong insured location on the registration form: many people assume the 'insured location' should be wherever they are going to seek care, but it should actually be the medical insurance handling agency at their home insured location. Second, still using the old physical card after registration—if the card status is abnormal or unactivated, network settlement will fail; the correct fix is to use the electronic medical insurance certificate instead. The fix for both failures is a ten-second action that is often dragged into a full round trip.

还有一点要提醒：{cn} 的医保经办窗口和社保办事大厅都在东环路 93 号片区，但医保在 1 号楼、社保在 93 号院，两处不是同一入口。同时办理两件事时可以一趟走完，但要预留出中间的排队时间，并分别取号。窗口办公时间以当日公示为准，遇到上午集中办理的高峰时，下午去通常更快。

One more thing to note: {cn} the medical insurance service window and the social-security service hall are both in the Donghuan Lu 93 area, but the medical insurance office is in 1 Lou while social security is at Yuan 93—they are not the same entrance. If you are handling both matters in one trip, you can walk it off in one go, but allow time for the queue between them and collect a number at each window separately. The window office hours are subject to the day's posted notice; if the morning sees a concentrated rush, heading over in the afternoon is usually faster.

六、办理流程

VI. Processing Procedure

1. 第一步（先分清是哪一类）：异地就医备案是「提前把就医地报上去」，门诊报销是「看完病之后报账」，两件事入口不同。备案要在就医前办，报账要在票据还没丢的时候办。
2. 第二步（线上备案）：打开国家医保服务平台 App 或电子医保卡，进入异地就医备案，按提示选择就医地、备案类型与人员信息后提交。即时生效的备案类型提交后即可使用。
3. 第三步（自检备案结果）：在 App 的异地就医备案查询里确认参保地显示正确。参保地必须是你的参保地医保经办机构，就医地是你要去的地方，两栏别填反。
4. 第四步（就医时带对卡）：就医时使用医保电子凭证或实体医保卡，异地联网结算需要医保卡状态正常且已完成备案。
5. 第五步（在定点直接结算）：在定点医疗机构就医，出示医保码或刷卡，符合政策的费用直接与医保基金结算，个人只付自付部分。
6. 第六步（不能直接结算的走手工报销）：因病情特殊无法联网结算的，保留全部票据与病历材料，到 {cn} 医保经办窗口提交，窗口会出具一次性告知。
7. 第七步（查询与复核）：提交后按告知的时限查询进度；待遇有异议的，先向参保地医保经办机构申请复核，不服可再申请行政复议或拨 12393。
8. Step 1 (first determine the category): Out-of-province medical treatment registration means 'reporting the destination area in advance'; outpatient reimbursement means 'filing for reimbursement after the visit'. The two processes have different entry points. Registration must be completed before seeking care; reimbursement must be done while you still have your receipts.
9. Step 2 (online registration): Open the National Medical Insurance Service Platform app or electronic medical insurance card, navigate to out-of-province medical treatment registration, select the destination area, registration type, and personal information as prompted, then submit. For registrations that take effect immediately, you can use your medical insurance right after submission.
10. Step 3 (verify registration result): In the app's out-of-province registration query section, confirm that the enrollment location is displayed correctly. The enrollment location must be the medical insurance agency where you are enrolled; the destination area is where you plan to seek care. Do not mix up the two fields.
11. Step 4 (bring the correct card when seeking care): Use your medical insurance electronic certificate or physical medical insurance card when visiting a healthcare provider. Cross-province direct settlement requires your medical insurance card to be in normal status and the registration to be completed.
12. Step 5 (direct settlement at designated institutions): When receiving treatment at a designated medical institution, present your medical insurance code or swipe your card. Eligible expenses will be settled directly with the medical insurance fund, and you only pay the portion covered out of pocket.
13. Step 6 (Manual reimbursement for cases that cannot be settled directly): Due to special medical conditions that prevent online settlement, keep all receipts and medical records, and submit them at the {cn} medical insurance service window. The window staff will provide a one-time written notice.
14. Step 7 (Inquiry and review): After submission, check the progress within the time limit stated in the notice. If you disagree with the benefit determination, first apply for a review with the medical insurance agency at your enrollment location. If still unsatisfied, you may apply for administrative reconsideration or call 12393.

备案后一定要做一次「自检」：在国家医保服务平台 App 里进异地就医备案查询，看参保地是不是你填的那个。如果参保地填成了参保地医保而不是就医地，异地结算会失败，这一步花十秒钟，能省一次来回。

After filing the record, do a quick self-check: open the National Healthcare Security Administration app, go to cross-region medical treatment record inquiry, and confirm the enrollment location is what you filled in. If you mistakenly entered your medical insurance location instead of the treatment location, cross-region settlement will fail. This step takes ten seconds and can save a round trip.

七、多久办完、要花多少钱

VII. How Long Does It Take and How Much Does It Cost

八、属地窗口

8. Local Service Windows

多数事项可以就近在属地窗口办。下面是 昌平 各窗口的地址与电话，出发前建议先电话确认该窗口是否办理本事项。

Most matters can be handled at nearby local service windows. Below are the addresses and phone numbers of each window in Changping. It is recommended to call ahead to confirm whether the window handles this matter before visiting.

九、常用政务热线

9. Common Government Service Hotlines

不确定归哪个部门、或者窗口电话打不通，直接打下面的热线。以下热线均为全国或北京市统一号码，昌平 同样适用。

If you are unsure which department handles this, or cannot reach the window by phone, call the hotline below directly. The following hotlines are all nationwide or Beijing unified numbers and also apply to Changping.

十、常见问题

10. Frequently Asked Questions