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 checking out. College students' medical insurance 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 in the overall payment form on the homepage of college students' medical insurance as required, and returning the college students' medical insurance to me.
After the insured college students go through the accounting procedures in the designated medical institutions, they will be directly settled in the designated medical institutions when they leave the hospital. Among them, college students will participate in the basic medical insurance for urban residents, which will be managed by designated medical institutions. If the insured college students need hospitalization, they can choose the designated medical institutions of the basic medical insurance for urban residents in Xi 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 in accordance with 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 the time of discharge.
Two, the implementation of fixed subsidies for maternity expenses:
The limit standard is: normal delivery in 800 yuan, cesarean section 1600 yuan. If the birth cost is lower than the limit standard, the subsidy shall be given according to the actual expenditure; Higher than the quota standard, according to the quota standard subsidies.
Third, the scope of chronic diseases:
Including: coronary atherosclerotic heart disease (excluding occult heart disease), chronic pulmonary heart disease, essential hypertension (above stage), cerebrovascular disease recovery period, decompensated cirrhosis, diabetes complicated with chronic complications, chronic glomerulonephritis and nephrotic syndrome, advanced malignant tumor, psychosis, lupus erythematosus, Parkinson's syndrome1kloc-0/disease.
Payment standard: outpatient chronic disease treatment will be settled annually. Within a year, if the medical expenses for outpatient treatment of chronic diseases in designated medical institutions exceed those in 350 yuan, the excess shall be paid by the overall fund and individual by 50%. In a year, the maximum amount of outpatient chronic disease medical expenses paid by the overall fund is 2000 yuan.
Four, outpatient accidental injury disease range:
Include fracture, joint dislocation and foreign body in respiratory tract.
Payment standard: The overall fund pays 50% and the individual pays 50% of the medical expenses for outpatient treatment of the above diseases caused by accidental injuries, and the cumulative maximum payment limit of the overall fund within one year is 1 000 yuan.
Suicide, self-mutilation (except mental illness), traffic accidents, fights, alcoholism, drug abuse and other diseases caused by crimes or violations of the Law on Public Security Administration Punishment will not be reimbursed by the overall fund.
Expense reimbursement procedure: the insured college students submit outpatient medical records, outpatient prescriptions, relevant bills, college students' medical insurance and relevant inspection reports to the medical insurance handling department of the university where they work, and the medical insurance handling department of the university will sort out and summarize them, fill out the Summary Table of Accidental Injury Expenses of Basic Medical Insurance for Urban Residents in Xi, and submit it to the municipal medical insurance handling institution in the first week of each month. City medical insurance agencies in accordance with the provisions of the audit settlement, the reimbursement of medical expenses through the medical insurance agencies in colleges and universities to pay the insured college students themselves, and will be credited to the reimbursement of medical insurance for college students.
Five, outpatient emergency rescue disease scope:
Including 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, acute heart failure, respiratory failure, renal failure and other major changes in vital signs.
Payment standard: the medical expenses incurred by the insured college students in the emergency department of the disease clinic shall be settled according to the settlement method of one-time hospitalization expenses.
Six, students need to be hospitalized in different places during holidays, internships, and suspension from school due to acute diseases:
You can go to a local designated medical institution or public hospital nearby, and the medical expenses incurred will be paid in full by the individual first. Collect and summarize college bills 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, hospital level certificate and hospitalization bill, college students' medical insurance guarantee and other related materials to the medical insurance handling department of the university where they are located. Medical insurance agencies in colleges and universities sort out and fill in the "Medical Expense Reimbursement Form of Basic Medical Insurance for Urban Residents" and "Summary Form of Sporadic Medical Expense Reimbursement for Urban Residents", and submit them to the municipal medical insurance agencies 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 of college students.
Legal basis:
Notice on doing a good job in the basic medical security for urban and rural residents in Chongqing in 2020. Improve the treatment guarantee mechanism
(four) the implementation of medical insurance benefits for residents. Give full play to the system dividend of residents' medical insurance, comprehensively realize urban and rural planning, adhere to fairness and inclusiveness, and strengthen the main guarantee function of basic medical insurance. Consolidate the level of hospitalization treatment, and the proportion of hospitalization expenses paid within the policy scope will reach 70%. Strengthen outpatient economic security, fully implement the drug security mechanism for outpatients with hypertension and diabetes, and standardize and simplify the identification process of outpatient chronic special disease security. Implement the new national medical insurance drug list and promote drug negotiation.
(5) Consolidate the level of serious illness insurance. Fully implement the deductible line to reduce and unify it to half of the per capita disposable income of residents, increase the proportion of payment within the policy to 60%, and encourage qualified areas to explore the cancellation of the ceiling line. Continue to increase preferential treatment for the poor. During the period of poverty alleviation, the deductible line of rural poor people was reduced by half compared with that of ordinary insured residents, and the payment ratio was increased by 5 percentage points. The maximum number of rural poor people will be completely abolished.
(6) Give play to the role of medical assistance. We will implement the aid policy for the needy, subsidize the destitute, the low-income households and the rural poor to participate in the residents' medical insurance, and timely transfer the subsidy funds according to the standard funds and the corresponding personnel expenses to ensure that the needy should be fully covered. Consolidate and improve the level of inpatient and outpatient assistance, increase the intensity of assistance for serious diseases, and explore the gradual transition from disease-based assistance to high-cost assistance for serious diseases. Combined with the situation of raising relief funds and the needs of relief objects, the annual relief limit will be raised as a whole.