杭州医保：异地就医备案与门诊报销

Hangzhou Medical Insurance: Filing for Out-of-Town Treatment and Outpatient Reimbursement

西湖胜境与钱塘江畔，江南雅韵、茶都烟雨与数字科技创新一体两面。。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 杭州 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。

The scenic beauty of West Lake alongside the Qiantang River, embodying both the grace of Jiangnan and the misty rain of the Tea Capital alongside the digital tech innovation. Filing for medical insurance is a prerequisite for being able to directly swipe the medical insurance card when seeking treatment out of town. In Hangzhou, the filing and outpatient reimbursement step can be completed online in just a few minutes, but there are clear guidelines on materials, timelines, and reimbursement ratios. Below we spell out the handling agency, window, criteria, and process.

一、先说结论：异地就医备案与门诊报销怎么办

I. Bottom Line: How to Handle Cross-Province Medical Treatment Filing and Outpatient Reimbursement

一句话结论：异地就医备案可以全程在「国家医保服务平台」App 或「浙里办」APP/小程序上提交，即时生效，不需要跑窗口；门诊报销则看是否在定点医疗机构——在定点直接刷医保码结算，不在定点要先垫付再回窗口报。杭州医保经办窗口在各区政务服务中心医保专窗（地址以浙里办公示为准），备案成功后建议在 App 里做一次参保地自检，避免填错就医地导致结算失败。

Bottom line: Cross-province medical treatment filing can be submitted entirely via the National Healthcare Security Administration App or the Zhe Li Ban (Zheliban) App/mini-program, takes effect immediately, and doesn't require a window visit. Outpatient reimbursement depends on whether you're at an accredited medical institution — at an accredited one, settle directly with your medical insurance QR code; at a non-accredited one, pay upfront and claim at the window later. Hangzhou's medical insurance service windows are located in each district's Government Service Center (addresses subject to Zhe Li Ban notices). After successful filing, it's advisable to verify your insured location in the App to avoid settlement failure from entering the wrong location.

杭州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窗口。

The two most common reasons for cross-province medical treatment filing failures in Hangzhou are not policy issues. First, entering the wrong insured location: many people mistakenly believe 'insured location' means where they are going to receive treatment, but it should actually be their insured medical insurance authority. Second, using an old physical card after filing — if the card is abnormal or unactivated, online settlement will fail. The correct approach is to use the medical insurance electronic credential directly. Both fixes are ten-second actions that often turn into a round-trip to the window.

还有一点要提醒：杭州医保经办窗口设在各区政务服务中心医保专窗（地址以浙里办公示为准），各区窗口工作日 9:00-12:00 / 13:30-17:00 左右对外服务。市医疗保障局热线 0571-12393 为 7×24 小时服务，建议出发前先拨打确认在岗情况，尤其是办理备案信息更正、门诊慢特病待遇认定等需要查系统的业务。线上渠道方面，国家医保服务平台 App 和「浙里办」APP/小程序均可办理异地备案，大部分业务无需跑窗口。

One more reminder: Hangzhou's medical insurance service windows are located at the medical insurance dedicated windows in each district's Government Service Center (addresses subject to Zhe Li Ban notices). Each district window is open on weekdays approximately 9:00–12:00 / 13:30–17:00. The Municipal Healthcare Security Bureau hotline 0571-12393 operates 7×24 hours. It is recommended to call ahead to confirm staffing status, especially for filings such as correcting filing information or recognizing outpatient chronic/special disease benefits that require system lookups. Online channels, including the National Healthcare Security Administration App and the Zhe Li Ban App/mini-program, handle most filing businesses without a window visit.

二、谁来办，电话怎么打

2. Who Handles It, How to Call

区分两个口径很重要：市医疗保障局负责政策、备案、待遇和基金的业务口径，各区医疗保障服务窗口是具体办事的地方。打 0571-12393 问「我能不能报」「报销比例多少」这类政策问题；打电话给各区窗口问「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 service channels: the Municipal Healthcare Security Bureau handles policy, filing, benefits, and fund-related matters; district medical insurance service windows handle in-person operations. Call 0571-12393 for policy questions like 'Can I get reimbursed?' or 'What's the reimbursement rate?'; call district windows for operational questions like 'Can I process this today?' or 'Is an appointment required?' Numbers marked 'official' are sourced from government websites and can be called directly.

三、去哪个窗口办，几点开门

3. Which counter to use and what are the opening hours

杭州各区医疗保障经办窗口设在各区政务服务中心医保专窗（地址以浙里办公示为准），与社保中心、公积金窗口通常在同一楼层但分区办理，别走错。市医疗保障局热线 0571-12393 为 7×24 小时服务，各区窗口工作日 9:00-12:00 / 13:30-17:00 左右对外服务，建议出发前先拨打 12393 确认在岗与预约要求，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。杭州也有线上渠道（国家医保服务平台 App、浙里办 APP/小程序），大部分备案类业务无需跑窗口。

Hangzhou's district-level medical insurance service windows are set up within each district's Government Service Center (addresses subject to Zhe Li Ban notices). They are typically on the same floor as the social security and housing fund windows but in separate sections — make sure you go to the right one. The Municipal Healthcare Security Bureau hotline 0571-12393 is available 7×24 hours; district windows serve the public on weekdays approximately 9:00–12:00 / 13:30–17:00. Call 12393 before heading out to confirm availability and appointment requirements, especially for filings such as correcting filing information or recognizing outpatient chronic/special disease benefits. Hangzhou also has online channels (National Healthcare Security Administration App, Zhe Li Ban App/mini-program) for most filing-related businesses that do not require a window visit.

四、谁能办（受理条件）

IV. Who Can Apply (Acceptance Conditions)

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 conditions below first to confirm you qualify before heading to the counter — this saves a wasted trip. Eligibility criteria are subject to the official service guide.

• 已在杭州参保、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杭州市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 insured in Hangzhou, whether enrolled in the employee medical insurance scheme or the urban and rural resident medical insurance scheme, are eligible to apply for cross-province medical treatment filing.
• Cross-province medical treatment (including hospitalization, outpatient visits, and special outpatient diseases) requires filing for cross-province medical treatment; intra-city cross-district treatment follows the specific requirements of Hangzhou's healthcare security authorities.
• Filing a record must be completed before seeking medical treatment elsewhere; only treatment after filing is covered. If you seek treatment first and file retroactively, it will generally be handled per policy—don't rely on after-the-fact filing.
• The validity period and cancellation rules differ between long-term residents and those seeking temporary medical care out of town. Long-term resident filings can be used multiple times, while temporary out-of-town filings expire by treatment visit.
• The insured must be in an active insurance status (not terminated, not receiving unemployment insurance benefits, or in any other suspended status) to normally enjoy direct cross-regional settlement.
• Recognition and filing of outpatient special disease benefits are two separate matters: filing determines 'whether you can use it elsewhere,' while disease category recognition determines 'the reimbursement ratio.' Both must be completed.

五、带什么材料

V. What Documents 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 documents at once is key to efficient processing. They are listed below by category — original / photocopy / to be filled out on-site — and missing even one item may result in your application being returned for correction.

• 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 itself is processed online and requires no paper materials; online submission requires personal real-name authentication and a linked mobile phone number.
• For proxy filing, a power of attorney and both parties' ID documents are required; online proxy filing follows the authorization flow of the chosen platform.
• When filing via a non-personal mobile phone, you must complete kinship or proxy authorization verification per platform requirements, or you will receive a notification that you do not qualify.
• For outpatient reimbursement (non-direct settlement), the following are required: original outpatient fee receipts, itemized fee lists, the person's own ID document, and a medical insurance card or electronic medical insurance certificate.
• Additional documents required for inpatient expense reimbursement: discharge summary (discharge record), itemized list of inpatient expenses, diagnosis certificate (if applicable), and billing receipts issued by the medical institution.
• For outpatient special-disease reimbursement, provide disease-identification materials (e.g., prior medical records, diagnosis certificate) along with the settlement voucher from that visit. Specific requirements are subject to the medical insurance agency's instructions.
• When entrusting another person to submit the reimbursement on your behalf, also provide a letter of authorization, a copy of the authorizer's ID, and the original ID of the authorized representative.
• Please do not misplace any original receipts in advance. Receipt verification for cross-region reimbursements may take longer, so we recommend keeping clear photocopies or photos for your records.

杭州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窗口。

The two most common reasons for cross-province medical treatment filing failures in Hangzhou are not policy issues. First, entering the wrong insured location: many people mistakenly believe 'insured location' means where they are going to receive treatment, but it should actually be their insured medical insurance authority. Second, using an old physical card after filing — if the card is abnormal or unactivated, online settlement will fail. The correct approach is to use the medical insurance electronic credential directly. Both fixes are ten-second actions that often turn into a round-trip to the window.

还有一点要提醒：杭州医保经办窗口设在各区政务服务中心医保专窗（地址以浙里办公示为准），各区窗口工作日 9:00-12:00 / 13:30-17:00 左右对外服务。市医疗保障局热线 0571-12393 为 7×24 小时服务，建议出发前先拨打确认在岗情况，尤其是办理备案信息更正、门诊慢特病待遇认定等需要查系统的业务。线上渠道方面，国家医保服务平台 App 和「浙里办」APP/小程序均可办理异地备案，大部分业务无需跑窗口。

One more reminder: Hangzhou's medical insurance service windows are located at the medical insurance dedicated windows in each district's Government Service Center (addresses subject to Zhe Li Ban notices). Each district window is open on weekdays approximately 9:00–12:00 / 13:30–17:00. The Municipal Healthcare Security Bureau hotline 0571-12393 operates 7×24 hours. It is recommended to call ahead to confirm staffing status, especially for filings such as correcting filing information or recognizing outpatient chronic/special disease benefits that require system lookups. Online channels, including the National Healthcare Security Administration App and the Zhe Li Ban App/mini-program, handle most filing businesses without a window visit.

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 或浙里办 APP/小程序，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，到各区政务服务中心医保专窗提交，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 0571-12393。
8. Step 1 (first, identify the category): Cross-region medical treatment registration means 'reporting your treatment location in advance,' while outpatient reimbursement means 'claiming expenses after treatment.' The two processes have different entry points. Registration must be completed before receiving care, and reimbursement claims should be filed before you lose your receipts.
9. Step 2 (online registration): Open the National Healthcare Security Administration App or the Zhejiang Government Services App/mini-program, navigate to Cross-Region Medical Treatment Registration, follow the prompts to select the treatment location, registration type, and personal information, then submit. Instantly effective registration types can be used immediately upon submission.
10. Step 3 (verify your registration result): In the App's cross-region medical treatment registration query, confirm that the 'insurance location' is displayed correctly. The insurance location must be the medical insurance agency where you are enrolled, and the treatment location is where you plan to receive care—do not swap the two fields.
11. Step 4 (bring the correct card when seeking treatment): Use your medical insurance electronic credential or physical medical insurance card when receiving care. Cross-region networked settlement requires the medical insurance card to be in normal status and the registration to have been completed.
12. Step 5 (Direct Settlement at Designated Institutions): When seeking medical care at a designated healthcare institution, present your medical insurance code or card. Expenses covered by policy are settled directly with the medical insurance fund; you only pay the out-of-pocket portion.
13. Step 6 (Manual Reimbursement for Non-Direct Settlement): If your condition prevents network settlement, keep all receipts and medical records. Submit them at the medical insurance service window of the district government service center; the window will issue a one-time written notice.
14. Step 7 (Inquiry and Review): After submission, check your progress within the time limit stated in the notice. If you disagree with the benefit decision, first request a review from the medical insurance agency at your insured location; if still unsatisfied, you may apply for administrative reconsideration or call 0571-12393.

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。如果参保地填成了就医地而不是参保地，异地结算会失败，这一步花十秒钟，能省一次往返窗口。杭州医保电子凭证与实体卡同效，异地联网结算建议优先使用医保电子凭证，减少因实体卡状态异常导致的结算失败。

After registering, do a quick self-check: go to Cross-Regional Medical Treatment Registration Inquiry in the National Medical Insurance Service Platform app and confirm that the insured location matches what you entered. If the insured location is mistakenly filled in as the treatment city instead of your actual insured location, cross-regional settlement will fail. This step takes ten seconds and saves one round trip to the service window. Hangzhou Medical Insurance electronic credential is equivalent to the physical card; for cross-regional network settlement, it is recommended to use the electronic credential first to reduce settlement failures caused by physical card status anomalies.

七、多久办完、要花多少钱

7. Processing time and cost

八、属地窗口

VIII. Local-Service Windows

多数事项可以就近在属地窗口办。下面是 杭州 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 a local service window near you. Below are the addresses and phone numbers for all Hangzhou service windows; we recommend calling ahead to confirm whether the window handles the matter you need.

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。以下热线均为全国统一号码，杭州 同样适用。

If you're unsure which department handles your issue, or can't get through to the window phone line, call one of the hotlines below directly. All the hotlines listed here are nationwide unified numbers and also apply to Hangzhou.

十、常见问题

X. Frequently Asked Questions