The outpatient medical expenses on campus shall be paid by colleges and universities at not less than 90%, and the rest shall be borne by individuals. Out-of-school outpatient and emergency medical expenses are paid according to the outpatient and emergency medical expenses of primary and secondary school students in residential insurance. Specifically, the deductible line for outpatient and emergency medical expenses is set in 300 yuan, and the accumulated part exceeding the deductible line every year is borne by the individual. The medical expenses of hospitalization and emergency observation room are also paid according to this standard.
Scope of use of medical insurance card:
1, the insured employees can use the password on the POS card to buy medicines in designated hospitals and pharmacies, but they cannot withdraw cash or transfer money. That is, the scope of use of urban medical insurance cards is also applicable to the scope of use of rural medical insurance cards.
2. Designated pharmacies: Medical insurance consists of two accounts: personal account and overall account. Personal accounts can be used to buy medicines at designated pharmacies, and are mainly responsible for the payment of outpatient expenses and hospitalization expenses paid by individuals. The overall account managed by the medical insurance center pays the expenses incurred by the insured who meet the local medical insurance reimbursement;
3. Designated hospitals: When you go to a designated hospital for medical treatment, you can show your medical insurance card to prove your enrollment and registration. Individuals do not need to pay first and then reimburse, and can directly settle medical insurance reimbursement with the hospital. Only when the account is settled can the self-funded part be paid with the balance of the medical insurance card or cash.
The reimbursement process after individuals pay medical insurance is generally as follows:
1. See a doctor: When you see a doctor or buy medicine in a medical institution, you need to show your medical insurance card, ID card and other relevant documents;
2. Preparation of reimbursement materials: after seeing a doctor, you need to go to a medical institution to obtain medical records, doctor's orders, prescriptions, receipts and other related materials, and fill in the relevant reimbursement application form;
3. Submit reimbursement application: submit the prepared reimbursement materials and application forms to the local social security bureau or medical insurance center for reimbursement application. You can also choose to apply for reimbursement online;
4. Review the reimbursement application: the local social security bureau or medical insurance center will review the submitted reimbursement application, and after the approval, the reimbursement will be credited to the personal bank account.
To sum up, the medical insurance policy and reimbursement ratio may be different in different regions, and the specific situation should be subject to local policies. At the same time, the scope and amount of medical insurance fund payment are also affected by different policies, and the specific reimbursement ratio and amount will also change due to different medical projects.
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.