Hospitalization in community hospitals can be reported as 90%
If the insured college students meet the payment scope of hospitalization, outpatient serious diseases, outpatient service and maternity medical expenses within a guarantee period, a Qifubiaozhun and a maximum payment limit shall be set up, and the part above Qifubiaozhun and below the maximum payment limit shall be paid in proportion. And the prenatal examination and maternity expenses in line with the national family planning policy will be included in the scope of fund payment. The maximum payment amount of the prenatal examination fee fund is 300 yuan. Maternity expenses are paid according to hospitalization expenses.
Hospitalization. Qifubiaozhun is 500 yuan, a tertiary medical institution, 400 yuan, a secondary medical institution, and 300 yuan, a first-class and below medical institution. If the insured college students are hospitalized several times in a settlement year, the minimum threshold will be gradually reduced, and the second and above hospitalization will be calculated according to 50% of the specified minimum threshold, but the minimum threshold will not be lower than 150 yuan. For the expenses above Qifubiaozhun and below the maximum payment limit, if they are treated in tertiary, secondary, primary and below medical institutions, the proportion of fund payment is 80%, 85% and 90% respectively.
Treatment of serious illness in outpatient department. There is no qifubiaozhun, and the medical expenses fund pays 75%.
Outpatient treatment. There is no minimum threshold. The fund will pay 40% of the expenses between 0 and 300 yuan, and the expenses above 300 yuan will be borne by individuals.
You need a Nanjing citizen card to see a doctor.
The labor and social security department of Nanjing made a "Nanjing citizen card" for each insured college student, and the insured college students took the card to the designated medical institutions for medical treatment. Business card printing costs are borne by college students themselves. Insured college students can choose a medical institution with outpatient serious illness qualification as their designated medical institution for outpatient serious illness. After college students are insured, the first-visit referral system is implemented, mainly in designated medical institutions or community health service institutions in colleges and universities. Need referral, the first medical institution is responsible for referral. Rescue is not limited to this. Insured college students need to bring "Nanjing Citizen Card" and "Outpatient Serious Illness Certificate" to the designated medical institutions for treatment. The insured college students who hold the Certificate of Outpatient Serious Illness are exempted from Qifubiaozhun for hospitalization.
During the internship in different places and during the winter and summer vacations, college students can seek medical treatment locally because of emergency hospitalization, and the hospitalization expenses incurred are paid in advance by individuals. After discharge, "Nanjing Citizen's Card", copies of medical records, hospitalization receipts, expense details, discharge summary and other materials. Will be submitted to colleges and universities in a unified way, and the colleges and universities will report to the Nanjing University Student Medical Insurance Agency for review and reimbursement.
Please note that these expenses are not reimbursed.
Not all medical expenses can be reimbursed. College students should pay attention to medical treatment. The fund will not pay the medical expenses incurred in the following circumstances: expenses incurred in non-designated medical institutions; Pay the expenses incurred during the interruption; The expenses incurred in handling the referral procedures in the hospital that did not specify the first visit; Expenses incurred for medical treatment in other places without approval and filing; Expenses outside the catalogue of residents' medical insurance drugs and medical services; Cost of family planning operation; Injuries caused by the insured college students' own violations of laws and regulations; Suicide and self-mutilation; During going abroad or leaving the country; Plastic surgery and cosmetic surgery; Traffic accidents, medical accidents, drug accidents, etc. The third party is liable for compensation; Other payment scope that does not meet the requirements of residents' medical insurance.