1. reimbursement of hospitalization medical expenses: when students come to the hospital with an IC card, they only need to pay part of the expenses borne by the individual, and the expenses paid by the pooling fund are directly settled by the hospital and the medical insurance center;
2. Reimbursement of daily outpatient medical expenses: according to the standard of 60 yuan for each student every year, the school will give subsidies, and students will hold campus cards and their student ID cards when they see a doctor. Students who did not participate in the daily outpatient medical insurance in that year can go through the formalities at the beginning of the first semester of the following year and enjoy the daily outpatient medical insurance benefits from the next month;
3. Casual reimbursement of outpatient medical expenses for accidental injuries: after the students have an accidental injury accident, I will go to the school medical insurance office for sporadic reimbursement with the receipt of outpatient medical expenses, a copy of medical records and relevant accident certificates (school certificate);
4. Reimbursement of medical expenses for hospitalization in local designated hospitals due to illness during the winter and summer vacations and holidays: Students can enjoy medical insurance benefits after the holidays if:
(1) If a patient is hospitalized in a local designated hospital due to illness, he/she will be reimbursed according to the regulations with the hospital discharge summary and expense list (examination fee, medical fee, operation fee, treatment fee, etc.) when returning to school. Meet the requirements during diagnosis and treatment).
(2) If the patient is hospitalized in a local non-designated hospital for emergency treatment, after the treatment, he will be reimbursed according to the regulations with the discharge summary and detailed list of expenses (examination fee, medical fee, operation fee, treatment fee, etc.). Meet the requirements during diagnosis and treatment).
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, the process and proportion of medical insurance reimbursement may be different in different regions and different types of medical insurance. Specifically, you can consult the local social security agency or inquire about the local medical insurance policy.
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.