Students who have purchased health insurance, then students can also enjoy health insurance reimbursement when they go to the hospital, the specific reimbursement rate according to the actual situation to determine.
A. How much is the reimbursement rate of the health insurance for students in other places
(1) The medical expenses incurred in outpatient clinics in accordance with the provisions of the following ratio will be reimbursed, and the rest will be paid by the individual:
1. The part of the medical expenses that is less than 1,000 yuan is reimbursed by 35%;
2. The part of the medical expenses that is more than 1,000 yuan (including 1,000 yuan), less than 5,000 yuan, 45% reimbursement;
3. Medical expenses above 5,000 yuan (including 5,000 yuan) and less than 10,000 yuan, 55% reimbursement;
4. Medical expenses above 10,000 yuan (including 10,000 yuan), 65% reimbursement.
(2) Reimbursement of eligible medical expenses incurred in hospitalization shall be given according to the following ratios, with the remainder paid by the individual, and the medical expenses for multiple hospitalizations within the year shall be calculated cumulatively:
1. For the portion of the medical expenses less than 10,000 yuan, the reimbursement ratios for those who seek medical treatment in third-level, second-level and first-level medical institutions shall be 55%, 65% and 75%, respectively;
2. For medical expenses above 10,000 yuan (including 10,000 yuan) and less than 20,000 yuan (including 20,000 yuan), the reimbursement rates are 60%, 70% and 80% for medical treatment at third-level, second-level and first-level medical institutions respectively;
3. For medical expenses above 20,000 yuan (including 20,000 yuan), the reimbursement rates are 65%, 75% and 75% for medical treatment at third-level, second-level and first-level medical institutions respectively;
4. ratios are 65%, 75% and 85% respectively.
Second, the medical insurance reimbursement scope covers which
In accordance with the provisions of the basic medical insurance does not pay for the cost of diagnostic and treatment items **** five categories.
The first category is the class of service items: some medical service fees, out-of-hospital consultation fees, medical records cost, etc.; visit fees, examination and treatment expedited fees, named surgery surcharge, named surgery surcharge, quality premium fees, self-requested special nurses and other special medical services.
The second category is the category of non-disease treatment programs: see the following analysis.
The third category is the category of diagnostic and therapeutic equipment and medically useful materials: the application of positron emission tomography (PET), electron beam CT, ophthalmic excimer laser therapy and other large-scale medical equipment for examination and treatment programs. Eyeglasses, denture, eye prosthesis, prosthetic limbs, hearing aids and other rehabilitative devices. All kinds of self-use health care, massage, examination and treatment equipment. Provincial price departments do not charge separately for disposable medical materials.
The fourth category is the category of therapeutic projects: all kinds of organ or tissue transplantation of organ or tissue source; in addition to kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation of other organs or tissue transplantation; myopic orthopedics; qigong therapy, music therapy, health care of nutritional therapy, magnetic therapy and other complementary therapeutic projects.
The fifth category is other categories: various scientific research, clinical verification of the diagnosis and treatment programs.
In addition, the basic medical insurance does not pay the cost of transportation, emergency vehicle fees; baby warming box fee, food warming box fee, nursing fee, cleaning fee, outpatient decoction fee; meal costs and other special living services. Patients are required to pay for all of the above items at their own expense.
The non-disease treatment items include these:
1, a variety of cosmetic and plastic surgery programs: such as acne, scar beauty, laser beauty, cosmetic dental cleaning, hair transplantation and so on.
2, orthopedic treatment programs: stuttering, dental irregularities, prosthetic restoration (including stump crowns, sets of crowns, mounted denture), dental implants, snoring surgery (except for respiratory distress), flat feet and other items (except for congenital strabismus, cleft lip and palate, and post-polio sequelae).
3. Various bodybuilding treatment programs: such as weight loss, fat gain, height increase, etc.
4, a variety of health check-up programs: such as employee physical examination, disease census, etc..
5, a variety of preventive, health care treatment programs: such as a variety of vaccine inoculation, fitness massage.
6, a variety of medical consultation, health forecasting treatment programs: such as a variety of disease consulting fees (except for psychological counseling carried out by the second and third-level mental health prevention and treatment institutions), finger pulse instrument, microcirculation checker, meridian diagnostic instrument (including traditional Chinese medicine computerized diagnostic instrument), the life of information diagnostic and treatment instrument.
7, a variety of medical appraisal projects: such as labor capacity appraisal (employee labor, industrial injuries, occupational disease diagnosis and appraisal), judicial appraisal of psychiatric patients, medical accidents appraisal, a variety of inspection fees, etc..
Three, medical insurance reimbursement amount has a limit
Medical reimbursement is a limit, regardless of which category of people, outpatient, emergency large medical expenses paid for the cost of the maximum limit is 20,000 yuan per year. But the reimbursement rate varies for different groups of people. And the maximum payment for hospitalization is 70,000 yuan from the basic medical insurance fund in one year.
Generally speaking, different regions have different economic development, so the reimbursement rate is also different, the following is an explanation of the situation of the ratio of Beijing employee medical insurance insurance.
After getting medical insurance, if you are an active employee, you can only be reimbursed for medical expenses over 1,800 yuan after visiting the outpatient or emergency clinic of a hospital, and the reimbursement rate is 50 percent. If you are a retiree under the age of 70, you can be reimbursed for expenses over $1,300, and the reimbursement rate is 70%. For retirees over the age of 70, expenses over $1,300 are reimbursed at 80%. For example, if you are an active employee and spend 2,500 yuan on an outpatient visit, then 50 percent of the 700 yuan portion, or 350 yuan, can be reimbursed.
In the case of hospitalization expenses, the starting amount is 1,300 yuan for the first time you use basic medical insurance to pay in a year in 2009, whether you are an active employee or a retiree. And for the second and subsequent hospitalization medical expenses, the starting amount is set at 50 percent, which is $650.
The standard of hospitalization reimbursement is related to the level of the hospital where the insured person is staying, for example, if the hospital is a tertiary hospital, from the starting standard to 30,000 yuan, the employee pays 15%, that is, 85% reimbursement; from 30,000 yuan to 40,000 yuan, the employee pays 10%, 90% reimbursement; more than 40,000 yuan to the maximum payment limit of the part of the cost, 95% of the cost can be reimbursed, and the employee only needs to pay 5%. And retirees personally pay 60 percent of the rate of active (that is, the aforementioned) employees, but below the starting standard, all paid by the individual.
Medicare reimbursements are capped at 20,000 yuan per year for outpatient care and 70,000 yuan per year for hospitalization.
According to the law it can be known that the health insurance reimbursement for students in other places choose the medical insurance designated medical institutions in the place of residence for medical treatment, the medical expenses incurred first by the individual full advance, medical treatment is over with the relevant materials for reimbursement.
Legal Objective:Article 28 of the Social Insurance Law
Conforms to the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as emergency and rescue medical expenses, in accordance with state regulations from the basic medical insurance fund.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.