In a settlement year, the hospitalization and outpatient medical fees for prescribed diseases incurred by university students that are in line with the scope of medical insurance expenditure are implemented according to the following regulations:
(1) In case of hospitalization, the individual will first bear a starting standard, which is as follows: 800 yuan for third-level medical institutions, 600 yuan for second-level medical institutions, and 300 yuan for other medical institutions and community health service institutions.
(2) The proportion to be borne by the coordinated fund is as follows:
1. For hospitalization above the starting payment standard up to RMB 20,000 (inclusive), the fund bears 64% if it occurs in a tertiary medical institution, 70% if it occurs in a secondary medical institution, and 76% if it occurs in other medical institutions and community health service institutions.
2. Above 20,000 yuan and up to 40,000 yuan (inclusive), the fund bears 70% of the expenses incurred in tertiary medical institutions; 75% of the expenses incurred in secondary medical institutions; and 80% of the expenses incurred in other medical institutions and community health service organizations.
3, more than 40,000 yuan to 150,000 yuan (inclusive), in the third-level medical institutions, the fund will bear 76%; in the second-level medical institutions, the fund will bear 80%; in other medical institutions and community health service organizations, the fund will bear 84%.
4, more than 150,000 yuan, occurring in tertiary medical institutions, the fund will bear 82%; occurring in secondary medical institutions, the fund will bear 85%; occurring in other medical institutions and community health service organizations, the fund will bear 88%.
(3) In a settlement year, the outpatient medical fees for specified diseases are settled as one hospitalization, but there is no starting standard. X. College students can choose their own medical treatment among the designated medical institutions announced by the municipal labor security administrative department. When seeking medical treatment, college students should present their ID cards and basic medical insurance cards or special medical records for outpatient treatment of specified diseases.
XI. If college students need to be hospitalized in a medical institution outside Hangzhou due to an emergency, they can choose a local designated medical institution for medical treatment and go through the registration procedures as stipulated within 15 days after hospitalization; if they are hospitalized in a non-designated medical institution in Hangzhou, they should go through the registration procedures as stipulated within 3 days after hospitalization; the medical expenses incurred by them shall be paid in full by the individuals, and then the medical institution shall go through the examination and approval procedures as stipulated in the regulations. The medical expenses incurred will be paid in full by the individual and then settled by the municipal medical insurance agency in accordance with the regulations.
If a university student suffers from a difficult and serious disease, which cannot be diagnosed and treated by the designated medical institutions in the city due to technical or equipment conditions, and needs to be transferred to other places for medical treatment, he/she shall fill out the "Hangzhou Urban Basic Medical Insurance Transferring Emergency Medical Treatment Registration Form" by the third-level and the corresponding designated medical institutions, and after being registered by the municipal medical insurance agency, he/she can be transferred to other places (limited to Shanghai and Beijing) to seek treatment at designated medical institutions for medical treatment, and the incurred medical expenses shall be paid in full by the individual and then transferred to the municipal medical insurance agency for examination and settlement according to the regulations. The medical expenses incurred will be paid in full by the individual and then reviewed and settled by the municipal health insurance agency according to the regulations.
XII. The medical expenses incurred by university students that are within the scope of medical insurance shall be settled as follows:
(1) The hospitalization and outpatient medical expenses for specified diseases incurred in the designated medical institutions in the city shall be settled in accordance with the provisions of Article 9 of the present Measures, of which the out-of-pocket, self-care, and out-of-pocket expenses shall be paid by the individuals.
(2) During the winter and summer vacations, school breaks due to illness or internships in accordance with the regulations of the universities, medical fees incurred in the relevant places of residence or internships that are in line with the scope of the medical insurance expenditures shall be settled in accordance with the relevant provisions of Article 9 of these Measures. Among them, the medical fees that meet the scope of medical insurance expenses incurred in medical institutions at the second level or above in municipalities, provincial capitals, and cities with single-listed plans outside of this city after being transferred to Shanghai and Beijing after registration or temporary outings will be settled by the individual by paying 10% of the medical fees at their own expense, and the remaining portion will be settled in accordance with relevant provisions of Article 9 of the present Measures.
(3) Medical fees incurred for emergency treatment, as well as medical treatment in other places or referral for treatment, shall be handled by the municipal health insurance agency for audit and settlement within thirty days after the completion of treatment. When going through the procedure of auditing and settlement of medical fees, the "Registration Form of Referral for Emergency Treatment of Hangzhou Municipal Basic Medical Insurance", medical records of medical treatment, original receipts of valid medical fees, detailed lists of expenses and certificates of the grade of the medical institution shall be presented.
Thirteen, college students should continuously participate in the insurance premiums during their study in Hangzhou until graduation. The number of years of continuous participation in the urban residence medical insurance during their study shall be calculated together with the number of years they have participated in the Hangzhou urban workers' basic medical insurance.
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