Medical insurance reimbursement for college students
First, the proportion of college students' medical insurance reimbursement
Medical expenses incurred by insured college students due to diseases above Qifubiaozhun (300 yuan) shall be compensated by stages according to the following standards, with the maximum annual compensation limit of 30,000 yuan.
(a) in accordance with the provisions of the outpatient medical expenses, according to the following proportion of reimbursement, the rest of the individual pays:
1. 1000 yuan, 35% of medical expenses will be reimbursed.
2. If the medical expenses are above 1000 yuan (including 1000 yuan) and less than 5,000 yuan, 45% will be reimbursed.
Medical expenses above 3.5000 yuan (including 5000 yuan) 10000 yuan shall be reimbursed by 55%.
4. Medical expenses above 10000 yuan (including10000 yuan) shall be reimbursed by 65%.
(two) in accordance with the provisions of the medical expenses incurred in hospitalization, according to the following proportion to be reimbursed, the rest of the individual pays, and the medical expenses of multiple hospitalizations during the year are calculated:
1. Medical expenses 10000 yuan or less, the reimbursement rates in tertiary, secondary and primary medical institutions are 55%, 65% and 75% respectively.
2. If the medical expenses 10000 yuan or more (including 10000 yuan) is less than 20000 yuan, the reimbursement rates in tertiary, secondary and primary medical institutions are 60%, 70% and 80% respectively.
3 medical expenses of more than 20 thousand yuan (including 20 thousand yuan), the proportion of reimbursement of tertiary, secondary and primary medical institutions is 65%, 75% and 85% respectively.
Second, the scope of medical insurance reimbursement for college students
First, there is no disease limit for hospitalization reimbursement. College students must pay a certain deposit to pay the expenses that need to be borne by individuals, and refund more and make up less when checking out. College students' medical insurance is temporarily kept by the hospital medical insurance office during hospitalization. After the discharge formalities are completed, the hospital medical insurance office is responsible for filling in the overall payment form on the homepage of college students' medical insurance as required, and returning the college students' medical insurance to me.
Secondly, the maternity expenses are subject to fixed subsidies. The quota standard is: normal delivery in 800 yuan, cesarean section 1600 yuan. If the birth cost is lower than the limit standard, the subsidy shall be given according to the actual expenditure; Higher than the quota standard, according to the quota standard subsidies.
3. Chronic diseases include coronary atherosclerotic heart disease (excluding occult type), chronic pulmonary heart disease, essential hypertension (above stage II), cerebrovascular disease in convalescence, decompensated cirrhosis, diabetes complicated with chronic complications, chronic glomerulonephritis and nephrotic syndrome, advanced malignant tumor, psychosis, lupus erythematosus and Parkinson's syndrome. Payment standard: outpatient chronic disease treatment will be settled annually. Within a year, if the medical expenses for outpatient treatment of chronic diseases in designated medical institutions exceed those in 350 yuan, the excess shall be paid by the overall fund and individual by 50%. In a year, the maximum amount of outpatient chronic disease medical expenses paid by the overall fund is 2000 yuan.
Fourthly, the scope of accidental injuries in outpatient service includes three diseases: fracture, joint dislocation and foreign body in respiratory tract. Payment standard: The overall fund pays 50% and the individual pays 50% of the medical expenses for outpatient treatment of the above diseases caused by accidental injuries, and the cumulative maximum payment limit of the overall fund within one year is 1 000 yuan.
The most important thing for college students to clarify the scope of medical insurance reimbursement is to let themselves "know fairly well" when paying independently. They can "invest" in medical insurance projects according to their own needs and reduce unnecessary expenses. Secondly, the clear division of the scope of medical insurance reimbursement for college students has also reduced their pressure for colleges and universities. Colleges and universities don't need to uniformly ask students to pay a certain fee, which avoids the troubles of unreasonable charges and students complaining that the fees paid are too high, and also avoids the misunderstanding that students claim that they don't know where the fees went in the later period.
Third, college students' medical insurance reimbursement process
1. Hospitalization medical expenses shall be paid by individuals in advance. After discharge, medical insurance card, ID card, outpatient medical record, discharge summary, total cost list (detailed cost list), disease diagnosis certificate, valid bill (original invoice), doctor's advice, copy of the first page of medical record, certificate issued by the school, transfer certificate and relevant certificate issued by the college shall be provided. For medical treatment in different hospitals, materials from different hospitals should be provided; In the same hospital, according to the different hospitalization time (before the expenses are written off, such as being treated in the same hospital after discharge), materials of hospitalization in different periods should also be provided;
2. Open the credit card settlement function: within three days of hospitalization, the student or student guardian or client will go to the medical department window of the service hall of the municipal medical insurance center with the student ID card, provincial social security card, hospitalization medical record, disease diagnosis certificate and certificate issued by the college;
3. Treatment of emergency expenses of non-designated medical institutions: within 3-5 working days of emergency, first contact or entrust others to register with the municipal medical insurance management center through the student medical insurance management center of our hospital, and the medical expenses will be paid in advance by myself. At the time of reimbursement, apply for reimbursement to the municipal medical insurance center according to the above reimbursement materials. (if you go to a non-medical insurance designated hospital or clinic for treatment, you will not be reimbursed. )