Legal analysis: 1, reimbursement requirements
School students, children and other participants under 18 years of age due to accidental injuries requiring outpatient emergency treatment, can be the nearest medical treatment, but the medical costs first by the individual advance payment.
2. Materials required for reimbursement
After the treatment is completed, the original outpatient medical record, the original valid bill (the invoice needs to be stamped with the seal of emergency); the list of expenses (the breakdown of the treatment fee, laboratory fee and examination fee); the prescription of medicines; the original medical record of the outpatient clinic; the copy of the personal page of the student's household register; and the copy of the ID card of the guardian (agent). Reimbursement procedures will be carried out at the medical insurance office in the district where the student lives.
3, the student health insurance reimbursement process
Students should be cured should be timely with the following certificates, information to the school financial office to fill out the claim, entrusted to handle the application for the payment of insurance premiums:
Industrial insurance company recognized the hospital issued the original medical cost vouchers (hospital charges for the unified documents);
Industrial insurance company recognized the hospital issued a diagnostic certificate (outpatient medical records or the hospital's diagnosis) Certificate (outpatient medical record or hospital discharge summary); a copy of my student.
4, reimbursement
The insurance company will transfer the compensation to the school account after the case is closed, the Finance Office will publish a notice on the bulletin board next to the school mailroom, and students should bring their ID cards to the Finance Office to collect the insurance premiums in a timely manner after seeing the notice.
5. Conditions of public medical care
Students should be admitted to the school hospital for outpatient and inpatient treatment. If their condition is serious and they need to be transferred to a hospital outside the school, they should obtain a referral order from the school hospital; otherwise, they can only apply for insurance premiums from the insurance company, and they cannot be entitled to the reimbursement of the school's public medical care.
6, public medical reimbursement
School public medical reimbursement, outpatient medical expenses by the school hospital arrangements for reimbursement once a year, the implementation of a fixed amount of lump sum system, inpatient medical costs according to the insurance company after the balance of the claim, in the fill in the public medical reimbursement, with the referral of the hospital by the school hospital director approval and signature, the financial services office in accordance with the provisions of reimbursement payments.
7, which does not belong to the medical insurance reimbursement
Medical materials, non-disease treatment items, all kinds of organ or tissue transplantation of organ or tissue source, diagnostic and therapeutic equipment.
Legal basis: The People's Republic of China Social Insurance Law Article 30 The following medical expenses are not included in the scope of payment by the basic medical insurance fund:
(1) Those that should be paid from the industrial injury insurance fund;
(2) Those that should be borne by a third party;
(3) Those that should be borne by the public *** health;
(4) Those that are not covered by the basic medical insurance fund. ) for medical treatment outside the country.
Medical expenses shall be borne by a third party in accordance with the law, and if the third party fails to pay or if the third party cannot be identified, the basic medical insurance fund shall pay in advance. The basic medical insurance fund shall have the right to recover the costs from the third party after the payment is made.