上海医保：异地就医备案与门诊报销

Shanghai Medical Insurance: Cross-Provincial Registration and Outpatient Reimbursement

长三角中心城市，金融科创双核驱动。。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 上海 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。

A core city in the Yangtze River Delta, driven by dual engines of finance and sci-tech innovation. Medical insurance registration is the prerequisite for directly swiping your medical insurance card for treatment outside your home region; the cross-regional medical treatment registration and outpatient reimbursement step can be completed online in just a few minutes in Shanghai, though the required materials, time limits, and reimbursement ratios have clear criteria. Below, we set out the handling authority, service windows, conditions, and procedures clearly.

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「随申办」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。上海医保经办窗口分布在各区政务服务中心，异地备案成功后建议先在 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 registration can now be completed entirely online. Submit through the National Healthcare Security Administration App, Electronic Medical Insurance Code, or 'Sui Shen Ban' and it takes effect immediately—no window visit needed. Outpatient reimbursement depends on whether you visit an in-network designated medical institution: use your medical insurance card directly at designated facilities, or pay upfront and claim reimbursement afterwards at non-designated ones. Shanghai medical insurance service windows are distributed across district government service centers. After successful cross-province registration, it's advisable to first run a self-check of your insured location in the App to avoid settlement failures caused by entering the wrong medical treatment location.

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 registration failures are not policy issues. First, entering the insured location incorrectly: many people mistakenly think 'insured location' should be the place they're traveling to, but it should actually be the healthcare security agency where they are insured. Second, attempting to settle using an old physical card after registration succeeds—if the card status is abnormal or unactivated, networked settlement will fail. The correct approach is to use the medical insurance electronic credential directly. Both fixes are ten-second actions that often end up requiring an unnecessary trip to the service window.

还有一点要提醒：上海医保经办窗口设在各区政务服务中心（地址以「一网通办」zwdt.sh.gov.cn 公示为准），与社保中心、公积金窗口同楼但楼层不同，去的时候可以一趟走完，但要分别取号排队。市医保局热线 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。上海也有线上渠道（国家医保服务平台 App、随申办小程序/APP），大部分备案类业务无需跑窗口，异地备案成功后可直接在 App 里做参保地自检，避免结算失败。

One more reminder: Shanghai's medical insurance service windows are located in each district's government service center (address subject to the 'One-Stop Government Online' zwdt.sh.gov.cn posting). They share the same building as the social security center and housing fund window but are on different floors, so you can finish everything in one trip but will need to collect separate queue numbers. The municipal healthcare security bureau hotline 12393 operates 24/7, 7 days a week; we recommend calling ahead to confirm staff availability, especially for system-requiring services such as registration information corrections and outpatient chronic/special disease benefit accreditation. Shanghai also offers online channels (the National Healthcare Security Services Platform App and Suishenban mini program/app), through which most registration-type services can be handled without visiting a window. After successful out-of-city registration, you can also perform self-checks on the app to avoid settlement failures.

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，医保经办窗口是具体办事的地方。打 12393 问「我能不能报」「报销比例多少」这类政策问题；打各区窗口电话问「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 sets of responsibilities: the Healthcare Security Bureau handles policy, registration, benefits and fund-related matters, while the medical insurance service windows are where actual transactions take place. Call 12393 for policy questions such as 'Am I covered?' or 'What is the reimbursement rate?'; call the district window phone numbers for operational questions like 'Can I come in today?' or 'Is an appointment required?' Numbers marked 'official' in the table are sourced from government website postings and can be dialed directly.

三、去哪个窗口办，几点开门

3. Which window to apply at, and opening hours

上海各区医保经办窗口设在各区政务服务中心（地址以「一网通办」zwdt.sh.gov.cn 公示为准），与社保中心、公积金窗口同楼但楼层不同，别走错层。市医保局不直接受理个人业务，具体经办由各区分办。黄浦、徐汇、静安、浦东等区窗口工作日 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。上海也有线上渠道（国家医保服务平台 App、随申办小程序/APP），大部分备案类业务无需跑窗口。

Shanghai's medical insurance service windows are located in each district's government service center (address subject to the 'One-Stop Government Online' zwdt.sh.gov.cn posting). They share the same building as the social security center and housing fund window but are on different floors—don't go to the wrong floor. The municipal healthcare security bureau does not directly accept individual cases; each district handles its own. Windows in Huangpu, Xuhui, Jingan, Pudong and other districts generally serve the public on weekdays 9:00–12:00 / 13:30–17:00. We recommend calling 12393 before departing to confirm availability and appointment requirements, especially for system-dependent services such as registration information corrections and outpatient chronic/special disease benefit accreditation. Shanghai also offers online channels (the National Healthcare Security Services Platform App and Suishenban mini program/app); most registration-type services do not require a window visit.

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.

• 已在上海参保、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上海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。
• Persons who are already insured in Shanghai, whether under the employee medical insurance scheme or the urban-rural resident medical insurance scheme, may apply for out-of-city medical treatment registration.
• Cross-provincial out-of-city medical treatment (including hospitalization, outpatient visits and special outpatient conditions) requires cross-provincial registration. Intra-city cross-district treatment is handled according to the specific requirements of Shanghai's healthcare security department.
• Registration must be completed before you seek medical treatment in the other location; only treatment received after registration is eligible. If you have already finished treatment and then apply retroactively, it will generally be handled in accordance with policy provisions—we do not recommend relying on post-treatment registration.
• 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 documents in one visit is the key to efficient processing. Below are listed by 'original / photocopy / to be filled on-site' — missing any item may result in being asked to 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 hospitalization expense reimbursement, additionally provide: discharge summary (discharge record), full hospitalization expense statement, diagnosis certificate (if applicable), and the medical institution's official billing 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 misplace original receipts in advance. Reimbursement document verification for out-of-city treatment may take a relatively long time; we recommend keeping clear photocopies or photos for your own records beforehand.

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 registration failures are not policy issues. First, entering the insured location incorrectly: many people mistakenly think 'insured location' should be the place they're traveling to, but it should actually be the healthcare security agency where they are insured. Second, attempting to settle using an old physical card after registration succeeds—if the card status is abnormal or unactivated, networked settlement will fail. The correct approach is to use the medical insurance electronic credential directly. Both fixes are ten-second actions that often end up requiring an unnecessary trip to the service window.

还有一点要提醒：上海医保经办窗口设在各区政务服务中心（地址以「一网通办」zwdt.sh.gov.cn 公示为准），与社保中心、公积金窗口同楼但楼层不同，去的时候可以一趟走完，但要分别取号排队。市医保局热线 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。上海也有线上渠道（国家医保服务平台 App、随申办小程序/APP），大部分备案类业务无需跑窗口，异地备案成功后可直接在 App 里做参保地自检，避免结算失败。

One more reminder: Shanghai's medical insurance service windows are located in each district's government service center (address subject to the 'One-Stop Government Online' zwdt.sh.gov.cn posting). They share the same building as the social security center and housing fund window but are on different floors, so you can finish everything in one trip but will need to collect separate queue numbers. The municipal healthcare security bureau hotline 12393 operates 24/7, 7 days a week; we recommend calling ahead to confirm staff availability, especially for system-requiring services such as registration information corrections and outpatient chronic/special disease benefit accreditation. Shanghai also offers online channels (the National Healthcare Security Services Platform App and Suishenban mini program/app), through which most registration-type services can be handled without visiting a window. After successful out-of-city registration, you can also perform self-checks on the app to avoid settlement failures.

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，到各区医保经办窗口提交，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 Healthcare Security Administration app or Electronic Health Insurance Card, go to Out-of-Town Medical Treatment Registration, select the treatment location, registration type, and personnel information as prompted, then submit. For registrations that take effect immediately, you can use your card right after submission.
10. Step 3 (Self-Check Registration Results): In the Out-of-Town Medical Treatment Registration query section of the app, confirm that the insurance location is displayed correctly. The insurance location must be your health insurance handling agency; the treatment location is where you're going—don't fill in these two fields incorrectly.
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 Non-Direct Settlement): If networked settlement is unavailable due to special medical conditions, keep all invoices and medical records, and submit them at the healthcare security office window in each district. The window will provide a one-time written explanation.
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，能省一次来回窗口。上海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 registration, it's important to do a self-check: go to the Out-of-Town Medical Treatment Registration query in the National Healthcare Security Administration app and verify whether the insurance location matches what you entered. If the insurance location is mistakenly filled as a city different from your treatment location, cross-provincial direct settlement will fail. This step takes ten seconds but can save a round trip to the service window. In Shanghai, the electronic health insurance and the physical card have equal validity; for cross-provincial networked settlement, the electronic is recommended to reduce settlement failures caused by abnormal status of the physical card.

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 上海 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 services can be handled at a nearby local service window. Below are the addresses and phone numbers of service windows in Shanghai. It is recommended to call ahead to confirm whether the window handles this service before you go.

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，上海 同样适用。

If you're unsure which department or window to contact, or if the window?S phone line is unreachable, call the hotline below directly. The following hotlines are all national or Beijing municipal unified numbers, also applicable in Shanghai.

十、常见问题

10. Frequently Asked Questions