Rules for reimbursement of students participating in medical insurance
First, the general outpatient service:
1. Take the medical insurance card and medical records with you when you go to the school hospital. For the first time, I didn't apply for medical records, but went to the infirmary (provided my 1 inch photo and medical insurance card).
2. If you need to go to an off-campus hospital, you must first sign a referral opinion from the attending physician of the school hospital before you can go to a designated hospital. Those who recommend themselves without approval will not be reimbursed for all expenses.
3. Materials to be prepared for reimbursement:
Medical record book, referral record of attending doctor in school hospital, medical insurance card, medical record of referral hospital, expense list, auxiliary examination results (original and photocopy provided above), and original invoice.
4. The college only reimburses the general outpatient expenses that meet the requirements and participate in medical insurance in our school.
2. Hospitalization emergency observation, special outpatient service, chronic disease outpatient service and hospitalization (swipe card)
1. Special outpatient diagnosis: emergency observation, malignant tumor chemotherapy, malignant tumor radiotherapy, uremia hemodialysis, uremia peritoneal dialysis, chronic aplastic anemia treatment, anti-rejection treatment after kidney transplantation, anti-rejection treatment after liver transplantation, hemophilia treatment, severe B thalassemia treatment, chronic hepatitis C treatment, family bed; Outpatient service for chronic diseases: hypertension, coronary heart disease, chronic heart failure (cardiac function above Grade III), anticoagulation after heart valve replacement, Parkinson's disease, epilepsy, diabetes, rheumatoid arthritis, systemic lupus erythematosus, chronic active hepatitis (B), liver cirrhosis (decompensated period), chronic glomerulonephritis, chronic renal insufficiency (non-dialysis), chronic obstructive pulmonary disease, Alzheimer's disease and affective psychosis.
2. If you are insured and hospitalized before getting the medical insurance card, you can pay a deposit equivalent to the medical expenses of this hospitalization to the hospital, and then go to the hospital for settlement after getting the medical insurance card, which can avoid the trouble of retroactive reimbursement.
3 did not receive a medical insurance card, but has been hospitalized and settled, and the medical expenses incurred during the winter and summer vacations due to illness need to be reimbursed to the medical insurance bureau at the actual period or the actual period in the account. The following information is required for reimbursement:
(1), the original medical expense receipt printed by relevant departments;
(2) Detailed list of medical expenses;
(3), discharge summary or diagnosis certificate;
(4) Copies of the front and back of the medical insurance card;
(5) A written report on the injury process, college certificate and a copy of hospital medical records (with the official seal of the hospital) or a certificate issued by the college must be submitted during the winter vacation;
(6), did not receive a medical insurance card, but has been hospitalized outside and has been settled in the medical insurance office to show proof of late card.
With the medical insurance card, you can swipe your card directly in the hospital.
How to use the student medical insurance card?
1. Before hospitalization or after discharge, use the medical insurance card to swipe the card directly at the hospital payment office. The system will directly settle the self-payment ratio and print the list.
2. Application scope of student medical insurance card: tertiary hospitals, secondary hospitals, primary hospitals and community health service centers.
3. What diseases are covered by the medical insurance card: special diseases in hospitalization and specialist outpatient service.
4, where the transfer of medical treatment, medical treatment in different places of insured patients to apply for reimbursement of hospitalization medical expenses, need to provide the following materials:
①IC card (medical insurance card);
② Invoice of hospitalization medical expenses;
③ Disease diagnosis certificate (stamped with special seal for disease certificate);
(4) Summary table of detailed classification of hospitalization medical expenses (stamped with special seal for charges);
(5) copy of long-term doctor's advice (stamped with special seal for medical record room);
6. Copy of short-term doctor's advice (with special seal for medical record room);
⑦ Discharge summary (stamped with special seal for medical record room);
(8) Reimbursement of the agent's ID card;
Pet-name ruby xx province basic medical insurance for medical treatment in different places insured hospitalization inspection list.
Or, after hospitalization, issue the disease certificate issued by the hospital and the certificate issued by the school, bring the medical insurance card and the above two certificates to the medical insurance center, open a unified medical card in the whole province, and then swipe the card directly to the affiliated hospital for treatment.
5. Students who have applied for medical insurance cards will no longer issue cards, and the original medical insurance cards can be used directly.
College students' medical insurance related knowledge
I. Necessary materials for medical reimbursement:
Original invoice, medical record, general list of expenses (which must be stamped with official seal), certificate of institutions (certificate of participation, certificate of accidental injury or certificate of hospitalization in different places) and other materials.
Second, outpatient reimbursement data:
1. Accidental injury of the person without responsibility (the "detailed course of injury" must be stated, and the College will issue the "Accidental Injury Certificate" (with the official seal of the College). The "detailed injury process" should be clear: who, when, where and why what kind of injury happened.
2, outpatient illness (malignant tumor radiotherapy and chemotherapy, leukemia radiotherapy and chemotherapy, uremia kidney dialysis needle, organ transplantation anti-rejection treatment, psychosis, tuberculosis, hemophilia ***7 kinds of outpatient illness). Application process of outpatient service for serious illness: I apply to the Municipal Medical Insurance Office, fill in the application form for outpatient service for serious illness subsidy, submit the patient's hospitalization medical records and copies of relevant inspection and laboratory reports in designated hospitals above Grade II in the past year, and submit them to the Municipal Medical Insurance Office in the first month of each quarter (1- 10), and issue a medical certificate for outpatient service for serious illness after being examined and approved by experts. Patients can go to designated hospitals for outpatient treatment.
Three, hospitalization reimbursement data:
1, local hospitalization: those who are hospitalized in local designated hospitals due to diseases or injuries of persons without responsibility can be reimbursed directly on the hospital network. The specific process is: on the first day of hospitalization, bring the patient's ID card to the medical insurance department of the hospital for filing, and reimburse it directly at the hospital when leaving the hospital.
Note: From now on, materials that can be reimbursed in designated medical insurance hospitals but cannot be directly reimbursed in hospitals will no longer be accepted by the Municipal Medical Insurance Office and will not be reimbursed.
2. Hospitalization in different places: if you are hospitalized in a designated medical institution outside the school, you can also submit a tape reimbursement after discharge. Among them, the original invoice, copy of hospitalized cases, total cost list, college certificate and other materials are needed in winter and summer vacations; At other times, when in hospital, you should fill in the Registration Form for Emergency Hospitalization of Medical Insurance, and report it to the medical insurance window of urban residents for the record. Materials that are not filed in time will not be accepted by the municipal medical insurance department from now on.
Fourth, receive the reimbursement form:
After the reimbursement form is issued, I need to bring my ID card, UnionPay card and reimbursement form to the No.8 window on the first floor of Taian Social Service Security Center. If you can't go in person, you can also find someone to act as an agent (the agent needs to bring the agent's ID card, reimburse my ID card, reimbursement form and UnionPay card).
Five, the school hospital:
Before each medical year, the medical expenses of the school hospital will be 100 yuan (adjusted in time with the municipal medical insurance policy), and will be reimbursed according to the proportion of 50% (with my ID card), and the students will bear the extra expenses themselves.
Six, matters needing attention:
1. All expenses incurred in private hospitals, clinics, pharmacies and other non-public medical institutions will not be reimbursed.
2. Traffic accidents will not be reimbursed.
3. Cosmetic corrective treatment will not be reimbursed, such as myopia, amblyopia, strabismus, tooth extraction, tooth filling and cosmetic surgery.
4, illegal crime, fighting, alcoholism, drug abuse, self-harm and other medical expenses will not be reimbursed.
5. The Municipal Medical Insurance Office requires that college students try not to hand in medical insurance materials separately. If there are any materials to be reimbursed, please submit them to the person in charge of medical insurance in our hospital first (the school generally collects them once a month).
Legal basis:
Article 12 of the Social Insurance Law of People's Republic of China (PRC) * * * The employing unit shall pay the basic old-age insurance premium according to the proportion of the total wages of employees stipulated by the state and record it in the basic old-age insurance pooling fund.
Employees shall pay the basic old-age insurance premium in accordance with the proportion of wages stipulated by the state and record it in their personal accounts.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic old-age insurance in the employing unit and other flexible employees who have participated in the basic old-age insurance shall pay the basic old-age insurance premiums in accordance with state regulations and record them in the basic old-age insurance pooling fund and individual accounts respectively.