1. Hospitalization: The patient is hospitalized in the hospital, and relevant materials such as hospitalization certificate and doctor's diagnosis certificate should be provided during treatment;
2. Reimbursement application: When the patient or his family leaves the hospital, they apply to the local rural cooperative medical management department for a second reimbursement for serious illness;
3. Review materials: The rural cooperative medical management department reviews the hospitalization certificate, doctor's diagnosis certificate and other materials provided by patients, and looks at other supporting materials related to reimbursement, such as payment vouchers;
4. Reimbursement ratio: the patient's medical expenses are reimbursed for the second time according to the reimbursement ratio stipulated by local policies;
5. Reimbursement settlement: the rural cooperative medical management department will transfer the amount of the second reimbursement to the bank account of the patient or his family.
Medical insurance reimbursement conditions:
1. Confirm the insured status: before seeking medical treatment, you need to confirm that you have participated in local medical insurance, which can be confirmed by means of social security card and medical insurance certificate;
2. Medical category: Medical insurance generally only reimburses therapeutic medical behaviors, such as outpatient service, hospitalization, surgery and examination. Some cosmetic medical behaviors, such as dental beauty and plastic surgery, are usually not covered by medical insurance reimbursement;
3. Medical expenses: Medical insurance will only reimburse medical expenses that meet the requirements, such as medical expenses, medicine expenses, examination expenses, operation expenses, etc. Personal expenses, medical insurance will not be reimbursed;
4. Hospital qualification: Medical insurance will only reimburse the medical expenses of legally operated medical institutions, such as public hospitals and qualified private hospitals. Medical insurance will not be reimbursed for illegal medical institutions or clinics.
To sum up, different regions may have different specific policies and reimbursement ratios for the second reimbursement of serious illness in rural cooperative medical care. Applicants should prepare relevant materials according to local policy requirements and apply for secondary reimbursement for serious illness.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.
The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.