According to the Detailed Rules for the Implementation of the Basic Medical Insurance for College Students in Yunnan Province (for Trial Implementation) (No.8 [2008] of Yun Lao She Fa) and the Notice on Standardizing the Work of Basic Medical Insurance and Serious Illness Insurance for College Students in Kunming in the 20 13 School Year (No.88 [2065438+03] of Yun Ren She Fa). Interim Measures for Overall Management of College Students' General Outpatients in Kunming, Yunnan Province (Notice of Yunrenshefa [2008] on Relevant Issues Concerning Adjustment of Medical Insurance Treatment for College Students in Kunming (Yunrenshefa [20 14]11) and on improving the basic standard of urban residents for 2014 years.
I. Organizational leadership
The school has established a leading group for student medical insurance of Yunnan University of Finance and Economics, with the following members:
Team leader: Xiong Shuxin
Deputy Director: Wang Xiaoping? Yang Xiaohong
Members: Finance Office, Student Affairs Office, Academic Affairs Office, graduate department, Logistics Group, heads of colleges.
The leading group is responsible for the leadership, organization and coordination of students' medical security work in our school, and timely handles emergencies and special matters in the implementation of medical insurance. The finance department is responsible for the management of relevant funds.
There is an office under the leading group, which is located in the student affairs office. The director is the director of the student affairs office, the deputy director is the deputy director in charge of student medical insurance and the dean of the school hospital, and the members are related staff. The Student Affairs Office is responsible for the registration, entry, change and cancellation of personal information of all kinds of insured students and the specific coordination of daily medical security for students; The school hospital is responsible for the medical management of students' general outpatient (emergency) clinics, reviewing and reimbursing the medical expenses of students' outpatient clinics, and assisting the provincial medical insurance to manage students' hospitalization and serious diseases.
Second, the scope of application of these rules
These rules apply to full-time undergraduates, postgraduates and doctoral students enrolled by Yunnan Medical Insurance Center. Students from state and city branches, on-the-job graduate students and international students are not included.
Three, the basic medical insurance premium standard and payment method
Every student 1 10 yuan (in case of adjustment of national policies, it shall be implemented according to relevant national policies), which shall be paid in one lump sum according to the educational system. Pay the social security card business card printing fee of 22 yuan/piece.
Four, the use of basic medical insurance premiums
The student basic medical insurance fund is mainly used to pay for general outpatient (emergency) clinic, chronic disease clinic, special disease clinic and hospitalization medical expenses. The scope of medication for students' basic medical insurance, the scope of payment for diagnosis and treatment items, the standard of service facilities and non-payment shall be implemented in accordance with the relevant provisions of the basic medical insurance for urban residents in Yunnan Province.
Five, the insured students enjoy the treatment
Students who participate in the basic medical insurance according to regulations will enjoy medical insurance benefits from September 1 day of the year of enrollment to August 3 1 day of the year of graduation, and graduates will stop enjoying medical insurance benefits from September 1 day of that year. During the period of suspension from school due to illness, continue to enjoy medical insurance benefits.
(1) General outpatient (emergency) clinic management and expense settlement
1. First visit: The school hospital is the first medical institution for students' general outpatient service. Students register at the school hospital with their social security cards and student ID cards.
2. Referral: The attending doctor will go to the designated hospital for medical insurance for college students with a referral form for students who need referral treatment after being diagnosed by doctors in the school hospital.
3. Emergency: In case of critical illness, students can go directly to the public hospital for diagnosis and treatment, and then go to the school hospital for filing within three days. If you need a follow-up visit, you must issue a referral form by the school hospital doctor.
4. General outpatient (emergency) medical expenses settlement
(1) settlement of medical expenses for general outpatient (emergency) consultation in school hospital
All general outpatient (emergency) medical expenses arising from medical treatment and treatment in the school hospital shall be paid directly by students with social security cards, of which 20% shall be borne by individuals and the remaining 80% shall be paid by the school outpatient department as a whole.
(2) Off-campus general outpatient (emergency) medical expenses settlement
① 50% of the consultation expenses of off-campus general outpatient (emergency) that meet the reimbursement conditions shall be borne by the individual, and the rest shall be paid by the school outpatient department as a whole.
② Students can only report the expenses of emergency and accidental injury outpatient service in public hospitals during holidays, internships and suspension from school.
③ Procedures for reimbursement of off-campus medical expenses: The medical expenses for off-campus medical treatment shall be paid in advance by the individual, and the social security card, student ID card, outpatient (emergency) medical records, invoices and referral forms shall be brought to the charge room of the school hospital for review and reimbursement. The medical expenses of those who have not gone through the referral procedures (except for emergency rescue) will not be reimbursed.
(3) The reimbursement procedures for general outpatient (emergency) medical expenses incurred by students must be completed within this school year, and the reimbursement time shall be extended at the latest 1 month.
(4) According to the Service Agreement of Designated Medical Institutions of Provincial Basic Medical Insurance in Yunnan Province, the school hospital should carefully identify the identity and documents of the insured when seeing a doctor. According to the relevant information provided by college students, the school hospital carefully examines the social security card and student ID card (or all-in-one card) to ensure that the card (card) is valid and the person card (card) matches, and registers according to the provisions of the provincial medical insurance center. When the invalid certificate or identity does not match, the school hospital may refuse to continue to provide services, detain the card (certificate) and report to the provincial medical insurance center in time.
(2) Chronic disease outpatient service
September 2004 1, 2065438, Kunming college students' medical insurance was implemented at the provincial level, and the overall policy of chronic diseases in urban residents' medical insurance clinics was implemented. The categories of illness and reimbursement are as follows:
1. Primary growth hormone deficiency in children, reimbursement item: drug treatment;
2. Children with bronchial asthma, reimbursement items: examination fees and drug treatment;
3. Children's attention deficit syndrome, reimbursement items: drug treatment;
4. Coronary heart disease myocardial infarction type, reimbursement items: drug treatment;
5. Diabetes, reimbursement items: laboratory fees and drug treatment;
6. Above the extremely high-risk group of hypertension, reimbursement items: drug treatment;
7. For hyperthyroidism and hypothyroidism, reimbursement items: laboratory fees and drug treatment;
8. Primary glaucoma, reimbursement items: examination fee and drug treatment.
The treatment standard is 1 1,000 yuan/school year, with no deductible and 50% reimbursement for outpatient service. School medical insurance handling personnel shall provide information to declare the treatment of chronic diseases according to the procedures, and enjoy the outpatient medical treatment of chronic diseases after being audited by the provincial medical insurance fund management center. College students who enjoy the treatment of chronic diseases choose two designated medical institutions that offer chronic disease clinics for medical treatment.
(3) Accidental injury clinic
When college students have accidental injuries caused by irresponsible people, they should go to the nearest public hospital, pay their own expenses first, and then submit them to the school hospital with the invoice, medical record and accidental injury description (one original and one copy each) stamped by the college. The hospital will submit the collected materials to the provincial medical insurance center for reimbursement. Matters that are not reimbursed by medical insurance shall be implemented with reference to item 5 of Article 8 of these Rules.
(4) Special disease outpatient service
1. The outpatient special diseases of college students' basic medical insurance include the following diseases: malignant tumor (outpatient radiotherapy and chemotherapy), chronic renal failure (outpatient dialysis), organ transplantation (postoperative rejection), systemic lupus erythematosus and aplastic anemia.
2. College students suffering from special diseases should submit a written application to the school hospital, and after being audited by the provincial medical insurance center according to the prescribed procedures, they will be issued a "Special Disease Treatment Card". College students who hold the Special Disease Treatment Card can enjoy the corresponding medical treatment for special diseases. Medical expenses incurred in special disease clinics are deductible in 300 yuan. Qifubiaozhun does not participate in the accumulation of hospitalization Qifubiaozhun, and the reimbursement ratio and maximum payment limit above Qifubiaozhun are consistent with hospitalization treatment.
(5) Hospitalization management and expense settlement
1. According to the principle of seeking medical treatment nearby, the designated medical institutions for students' basic medical insurance in Yunnan University of Finance and Economics are: Yunnan Second People's Hospital (Red Cross Hospital), Yunnan Hospital of Integrated Traditional Chinese and Western Medicine, and Chenggong District People's Hospital (emergency rescue is not limited to designated hospitals, but can be seen in any public hospital in Kunming).
2. The hospitalization Qifubiaozhun, the first hospitalization in the school year: level 1 medical institution 100 yuan, level 2 medical institution 300 yuan, level 3 medical institution 600 yuan. The reimbursement rate of the first-level hospital is 90%, the second-level hospital is 80%, and the third-level hospital is 60%. The maximum payment limit of the basic medical insurance fund is 30,000 yuan.
3. If the out-of-pocket expenses of college students in Kunming Province do not reach 2,000 yuan, the reimbursement ratio of medical expenses within the policy scope shall be supplemented by the basic medical insurance fund to 90%.
4. The deductible line of serious illness insurance for college students in Kunming is 2,000 yuan for personal medical expenses, and the part of personal expenses exceeding 2,000 yuan is reimbursed by serious illness insurance. The reimbursement rate of serious illness insurance is unified to 90%, and there is no capping line for reimbursement. Personal expenses included in serious illness reimbursement include: deductible line of basic medical insurance for special diseases of college students' in-patient and out-patient, part borne by individuals in proportion, part paid in advance for class B drugs and diagnosis and treatment items, and medical expenses exceeding the top line of basic medical insurance.
5. Students who are sick and need hospitalization must go to the school hospital to issue referral procedures, and with their student ID cards and social security cards, they can go to the designated medical institutions that offer medical insurance for college students for hospitalization (except for emergency rescue). Its medical expenses are directly settled by the provincial medical insurance center and designated medical institutions. The expenses of going out for medical treatment without authorization will not be reimbursed.
6. During holidays, internships and suspension from school, students should go to the local public hospital for medical treatment due to critical illness, and file with the school hospital within one week. Medical expenses are paid in full by the individual first, and then reimbursed by the school hospital to the provincial medical insurance center after medical treatment. The materials required for reimbursement (one original and one copy each) include: hospitalization invoice, illness certificate, discharge certificate, expense list, student ID card, medical insurance card, description of the situation (stamped by the college), ID card or household registration book of the place where the household registration is located, and certificate of internship unit.
7. If it is necessary to be transferred out of the province for medical treatment due to illness, at least the consultation opinions of the chief physician of the secondary to tertiary medical institutions shall be provided, which shall be sent to the provincial medical insurance center for examination and approval after being stamped by the transferred hospital. Medical expenses are paid in full by the individual first, and then reimbursed by the school hospital to the provincial medical insurance center after medical treatment. The materials required for reimbursement (one original and one copy each) include: approval form for medical treatment outside the province, hospitalization invoice, illness certificate, discharge certificate, expense list, student ID card, medical insurance card, and materials stamped by the college.
8. The hospitalization expenses of freshmen who have not issued a card need to be paid in advance by themselves, and then reimbursed after the medical insurance card is issued. The materials required for reimbursement (one original and one copy each) include: hospitalization invoice, illness certificate, discharge certificate, expense list, materials stamped by the college, student ID card and medical insurance card.
(6) Childbearing expenses
The maternity expenses of insured college students in provincial universities in Kunming, which meet the policy requirements, are included in the scope of medical insurance reimbursement for urban residents, and the basic medical insurance is uniformly reimbursed 1650 yuan.
(7) Accidental death allowance
Family members of college students who died of accidents or diseases after enrollment can apply to the provincial medical insurance center for an accidental death subsidy of 10000 yuan. Application materials (in duplicate) include: beneficiary's ID card, household registration book, death certificate of deceased college students, household registration cancellation certificate, student ID card and medical insurance card.
(8) Refusal to pay
Under any of the following circumstances, the basic medical insurance fund and the supplementary medical insurance fund will not pay the medical expenses incurred:
1. Expenses beyond the basic medical drug list, diagnosis and treatment items and service facilities standards (except first aid).
2. Public health services such as health examination, planned immunization, preventive health care and health education.
3. Medical expenses for going out for medical treatment without going through the referral examination and approval procedures.
4. Self-purchased drugs, registration, home visits, ambulances, Chinese medicine decoction, psychological consultation, plastic surgery, tooth implantation, tooth washing, traffic accidents, alcoholism, drug abuse, fighting, suicide, self-mutilation, self-immolation and medical expenses increased due to medical accidents are beyond the medical expenses in medical insurance coverage.
5. Other expenses not paid according to regulations.
Intransitive verb others
(1) The Office of the Leading Group for Student Basic Medical Insurance of Yunnan University of Finance and Economics shall be responsible for the interpretation of these rules.
(II) The original "Detailed Rules for the Implementation of the Basic Medical Insurance for Students of Yunnan University of Finance and Economics (Trial)" [2008] No.33 document ceased to be implemented as of the date of implementation of these Detailed Rules.
(3) These Rules shall be implemented as of September 1 2065438.