Issues related to medical insurance reimbursement for college students Date of publication: January-May, 21 Number of views: 177 Author: Student Affairs Office of Institute of Materials 1. There is no limitation on reimbursement for hospitalization expenses. Procedures: If the diseases of the insured college students are diagnosed by the attending doctor in the outpatient clinic and really need hospitalization, they should go through the formalities at the medical insurance office of the designated medical institution with the Medical Insurance Guarantee for College Students, student ID card and hospitalization card. The hospital medical insurance office is responsible for checking to ensure that the person and certificate are consistent and prevent imposters. 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 they check out. The Medical Insurance for College Students 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 out the overall payment form on the front page of the Medical Insurance for College Students as required, and returning the Medical Insurance for College Students to me. After the insured college students go through the formalities of posting accounts in designated medical institutions, they will settle accounts directly in designated medical institutions when they leave the hospital. Among them, college students will participate in the basic medical insurance for urban residents and be managed by designated medical institutions. If the insured college students need hospitalization, they can choose the designated medical institution of basic medical insurance for urban residents in Xi 'an 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 according to 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 one time when leaving the hospital. Specific settlement standards are as follows: Qifubiaozhun is divided into community health service institutions 2 yuan, first-class hospital 3 yuan, second-class hospital 4 yuan and third-class hospital 5 yuan according to the level of designated medical institutions. Payment standard of community health service institutions: 8% of the overall fund payment and 2% of the individual commitment; First-class hospital: 7% from the overall fund and 3% from the individual; Secondary hospitals: 6% from the overall fund and 4% from individuals; Third-level hospitals: 5% from the overall fund and 5% from the individual. 2. Maternity expenses shall be subsidized by quota. The quota standard is: normal delivery in 8 yuan, and cesarean section is 16 yuan. If the birth cost is lower than the limit standard, the subsidy shall be paid according to the actual expenses; Above the quota standard, according to the quota standard subsidies. 3. The scope of chronic diseases includes: coronary atherosclerotic heart disease (excluding occult type), chronic pulmonary heart disease, essential hypertension (above phase II), cerebrovascular disease recovery period, decompensated cirrhosis, diabetes complicated with chronic complications, chronic glomerulonephritis and nephrotic syndrome, advanced malignant tumor, mental illness, lupus erythematosus and Parkinson's disease. Payment standard: outpatient treatment of chronic diseases shall be settled annually. In a year, if the medical expenses for outpatient treatment of chronic diseases in designated medical institutions exceed 35 yuan, the excess will be paid by the overall fund and the individual by 5%. In a year, the maximum amount of medical expenses for chronic diseases in outpatient clinics paid by the overall fund is 2 yuan. Expense reimbursement procedure: college students suffering from the above-mentioned chronic diseases shall submit outpatient invoices, outpatient medical records, outpatient prescriptions, diagnosis certificates, Medical Insurance for College Students and other materials to the medical insurance handling department of the university where they are located in early September each year, and the medical insurance handling department of the university shall sort out and summarize them, and fill out the Summary Table of Chronic Disease Subsidies for Outpatients of Basic Medical Insurance for Urban Residents in Xi 'an (Table 28), and then submit it to the municipal medical insurance handling institution in the second week of October. City medical insurance agencies in accordance with the provisions of the audit and settlement, the reimbursement of medical expenses through the medical insurance agencies in colleges and universities to the insured college students themselves, and the reimbursement of expenses recorded in the "medical insurance for college students". 4. The scope of outpatient accidental injuries includes three diseases: fracture, joint dislocation and foreign body in respiratory tract. Payment standard: 5% of the medical expenses for outpatient treatment of the above-mentioned diseases caused by accidental injuries shall be paid by the overall fund and 5% by individuals, and the cumulative maximum payment of the overall fund to 1 yuan within one year. For suicide, self-mutilation (except mental illness), traffic accidents with third-party responsibilities, fights, fights, alcoholism, drug abuse and other above-mentioned diseases due to crimes or violations of the Law on Public Security Administration Punishment, the overall fund will not reimburse expenses. Reimbursement procedures: The insured college students will submit outpatient medical records, outpatient prescriptions, related bills, "College Students' Medical Insurance" and relevant inspection reports to the medical insurance agency of their universities. Medical insurance agencies in colleges and universities sort out and summarize, and fill in the Summary of Accidental Injury Expenses of Outpatient Service of Basic Medical Insurance for Urban Residents in Xi 'an, and submit it to the municipal medical insurance agencies in the first week of each month. City medical insurance agencies in accordance with the provisions of the audit and settlement, the reimbursement of medical expenses through the medical insurance agencies in colleges and universities to the insured college students themselves, and the reimbursement of expenses recorded in the "medical insurance for college students". 5. The scope of outpatient emergency rescue includes coma, severe shock, massive hemorrhage, poisoning, severe dehydration, febrile convulsion, severe dyspnea caused by severe trauma, spontaneous or traumatic pneumothorax, hemopneumothorax, laryngeal infarction, tracheobronchial obstruction, severe arrhythmia, life-threatening internal and external bleeding caused by various reasons, and vital signs such as acute heart failure, respiratory failure and renal failure. Payment standard: the medical expenses incurred by the insured college students in outpatient emergency treatment of diseases shall be settled according to the settlement method of one hospitalization expense. Expense reimbursement procedure: The insured college students will submit the outpatient invoices, outpatient rescue medical records, medical expense list, and College Students' Medical Guarantee to the medical insurance agency of the university where they are located, and the medical insurance agency of the university will organize and summarize them in the first weekly of each month. City medical insurance agencies in accordance with the provisions of the audit and settlement, the reimbursement of medical expenses through the medical insurance agencies in colleges and universities to the insured college students themselves, and the reimbursement of expenses recorded in the "medical insurance for college students". 6. Students who need to be hospitalized in different places due to critical illness during holidays, internships and suspension from school can go to the local designated medical institutions or public hospitals nearby, and the medical expenses incurred will be paid in full by individuals first. Collect and summarize bills in colleges and universities 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, certificate of hospital level, hospitalization bill, medical insurance guarantee for college students and other relevant materials to the medical insurance handling department of the university where it is located. The medical insurance handling department of the university will sort out and fill in the Medical Expense Reimbursement Form of Basic Medical Insurance for Urban Residents in Xi 'an and the Summary Form of Sporadic Medical Expense Reimbursement for Urban Residents in Xi 'an, and submit it to the municipal medical insurance 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 for College Students. The above is the specific reimbursement procedure after the medical guarantee is completed. Before that (that is, September 1-January 5, 21), the materials needed are: outpatient bills, outpatient medical records, relevant examination and treatment reports, outpatient prescription hospitalization bills and expense lists. The first page of medical records, long-term temporary medical orders, diagnosis certificates, certificates of foreign hospitals and other materials are

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