Accidental fractures can be reimbursed if medical insurance premiums are paid according to regulations.
The reimbursement ratio of cooperative medical care is as follows:
1, outpatient compensation:
60% of medical expenses can be reimbursed for seeing a doctor in the village clinic and the village center clinic; 40% of medical expenses can be reimbursed for medical treatment in township hospitals; 30% of medical expenses can be reimbursed for seeing a doctor in a secondary hospital; In tertiary hospitals, 20% of medical expenses can be reimbursed;
2, hospitalization reimbursement ratio:
In township hospitals, 60% of medical expenses can be reimbursed; 40% of medical expenses can be reimbursed for seeing a doctor in a secondary hospital; In tertiary hospitals, 30% of medical expenses can be reimbursed;
3, serious illness compensation:
Where the medical expenses of inpatients participating in the new rural cooperative medical system exceed 5,000 yuan at one time or for the whole year, they will be compensated by stages, that is, 500 1- 1 0,000 yuan will be compensated by 65%,1-kloc-0/,and 800 yuan will be compensated by 70%.
The reimbursement process of cooperative medical insurance is as follows:
1. Patients who have participated in the cooperative medical insurance can submit claims directly by swiping their cards at the designated medical institutions of township-level general outpatient clinics in the region with their valid certificates and medical cards, and be hospitalized in the designated medical institutions in the region and outside the region, and can submit claims directly when they are discharged.
2. Insured patients are hospitalized in secondary and above public hospitals outside the city. Within 3 months after discharge, the insured or their families will submit the original invoice of medical expenses, detailed list of hospitalization expenses summary table, discharge summary, outpatient medical record, medical card, patient ID card, household registration book and agent ID card to the new rural cooperative medical system window of the district administrative service center for reimbursement of medical expenses;
3. Outpatient reimbursement for special diseases can be applied to the new rural cooperative medical management center with materials such as cases, relevant examinations, laboratory tests, certificates of medical institutions and the Approval Form for Outpatient Treatment of Special Diseases issued by designated medical institutions at or above the second level. After examination and approval, outpatient medical expenses can be included in the scope of reimbursement of the new rural cooperative medical fund and reimbursed annually according to the hospitalization reimbursement standard;
4. After being discharged from hospital due to accidental injury, the hospitalized patients shall submit the confirmation certificate of the cause of accidental injury and the medical records of the hospital with the signature and seal of the village (residence) where the household registration is located. Those who cannot provide valid certificates and records will not be accepted. Once it is investigated and audited by the new rural cooperative medical system, it will be reimbursed once it is true. If the responsibility is the responsibility of a third party, it will not be reimbursed.
To sum up, the fracture caused by personal carelessness can apply for the corresponding medical insurance reimbursement.
Legal basis:
Article 24 of People's Republic of China (PRC) Social Insurance Law
The state establishes and improves the new rural cooperative medical system. Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25
The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.