What is the scope of medical insurance reimbursement for college students?

1. There is no disease limitation 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.

After the insured college students go through the accounting procedures in the designated medical institutions, they will be directly settled in the designated medical institutions when they leave the hospital. Among them, college students will participate in the basic medical insurance for urban residents, which will be managed by designated medical institutions. If the insured college students need hospitalization, they can choose the designated medical institutions of the basic medical insurance for urban residents in Xi for medical treatment. Emergency treatment and patient rescue are not subject to this restriction. The scope of medication, diagnosis and treatment items and service facilities for college students to participate in the basic medical insurance for urban residents shall be temporarily implemented in accordance with the relevant provisions of the basic medical insurance for urban employees. The medical expenses that should be borne by the individual shall be settled by the individual at the time of discharge.

2. The measures for the implementation of the fixed subsidy for maternity expenses are as follows:

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. The scope of chronic diseases includes:

Coronary atherosclerotic heart disease (excluding occult heart disease), chronic pulmonary heart disease, essential hypertension (above stage II), cerebrovascular disease recovery period, 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.

4. The scope of accidental injuries in outpatient service includes 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. Suicide, self-mutilation (except mental illness), traffic accidents, fights, alcoholism, drug abuse and other diseases caused by crimes or violations of the Law on Public Security Administration Punishment will not be reimbursed by the overall fund.

Expense reimbursement procedure: the insured college students submit outpatient medical records, outpatient prescriptions, relevant bills, college students' medical insurance and relevant inspection reports to the medical insurance handling department of the university where they work, and the medical insurance handling department of the university will sort out and summarize them, fill out the Summary Table of Accidental Injury Expenses of Basic Medical Insurance for Urban Residents in Xi, and submit it to the municipal medical insurance handling institution in the first week of each month. City medical insurance agencies in accordance with the provisions of the audit settlement, the reimbursement of medical expenses through the medical insurance agencies in colleges and universities to pay the insured college students themselves, and will be credited to the reimbursement of medical insurance for college students.

5. The scope of outpatient emergency rescue diseases includes:

Coma, severe shock, massive hemorrhage, poisoning, severe dehydration, febrile convulsion, severe dyspnea caused by severe trauma, spontaneous or traumatic pneumothorax, hemopneumothorax, laryngeal infarction and tracheobronchial obstruction, severe arrhythmia, life-threatening internal and external bleeding, acute heart failure, respiratory failure, renal failure and other vital signs caused by various reasons. Payment standard: the medical expenses incurred by the insured college students in the emergency department of the disease clinic shall be settled according to the settlement method of one-time hospitalization expenses.

6 students need to be hospitalized in different places during holidays, internships and suspension due to major diseases;

You can go to a local designated medical institution or public hospital nearby, and the medical expenses incurred will be paid in full by the individual first. Collect and summarize college bills and report them to the municipal medical insurance agency for settlement. After discharge, submit the diagnosis certificate, copy of hospitalization medical records (including the first page of medical records, discharge records and long-term and temporary doctor's orders), detailed list of hospitalization expenses, hospital level certificate and hospitalization bill, college students' medical insurance guarantee and other related materials to the medical insurance handling department of the university where they are located. Medical insurance agencies in colleges and universities sort out and fill in the "Medical Expense Reimbursement Form of Basic Medical Insurance for Urban Residents" and "Summary Form of Sporadic Medical Expense Reimbursement for Urban Residents", and submit them to the municipal medical insurance agencies in the first week of each month. The municipal agency shall review the materials submitted by colleges and universities, and after being signed by the section chief and the director in charge, the reimbursement expenses shall be returned to the medical insurance agency of colleges and universities, which shall distribute them to the insured college students and record them in the medical insurance of college students. College students' medical insurance reimbursement has its specific provisions, which vary from place to place. You can learn about local policies before reimbursement.

The scope and proportion of college students' medical insurance reimbursement

If you are a prospective college student who is about to enter a university campus, or a college student who is studying on campus, then you need to know something about medical insurance for college students, because you may use it if necessary. Today, I will introduce the scope and 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.

(1) The outpatient medical expenses that meet the requirements shall be reimbursed according to the following proportion, and the rest shall be paid by individuals themselves: 1. 35% of the medical expenses that are less than 1000 yuan; 2. Medical expenses 1 1,000 yuan or more (including 1 1,000 yuan), and the part less than 5,000 yuan shall be reimbursed by 45%; Medical expenses above 3.5,000 yuan (including 5,000 yuan)10,000 yuan shall be reimbursed by 55%; 4. Medical expenses above 10000 yuan (including10000 yuan) shall be reimbursed by 65%.

(two) the medical expenses incurred in the hospital in accordance with the provisions shall be reimbursed according to the following proportion, and the rest shall be paid by the individual. Cumulative calculation of medical expenses incurred in multiple hospitalizations during the year: 1. The proportion of reimbursement for medical expenses below 1 10,000 yuan in tertiary, secondary and primary medical institutions is 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.