Fuzhou University Student Medical Insurance Project

1. Basic Principles of Basic Medical Insurance for College Students: All college students within the jurisdiction of our city will be included in the scope of basic medical insurance for urban residents; focus on ensuring college students’ inpatient and outpatient medical care for serious illnesses, and continue to do a good job in daily medical work, and gradually Improve the level of medical security; establish and improve the fund-raising mechanism and cost-sharing mechanism for medical insurance, and provide key subsidies to college students whose families have financial difficulties; the medical insurance for college students implements the "Trial Measures for Basic Medical Insurance for Urban Residents in Fuzhou" (Rongzheng Zongzong [2007] 249 Number). 2. Participants in the basic medical insurance for college students are enrolled in various full-time ordinary colleges and universities (including private colleges, independent colleges, full-time ordinary classes in adult colleges and universities) and scientific research institutes (hereinafter referred to as colleges and universities) within the jurisdiction of Fuzhou City. Full-time undergraduate and junior college students and full-time postgraduate students receiving general higher education (hereinafter collectively referred to as college students), including overseas Chinese, Hong Kong, Macao and Taiwan college students. The university will review the content of the materials, enter and summarize personal basic information, and submit the basic information, relevant forms and premiums collected to the Municipal Medical Insurance Center in accordance with regulations. The university will review the content of the materials, enter and summarize personal basic information, and submit the basic information, relevant forms and premiums collected to the Municipal Medical Insurance Center in accordance with regulations. 3. How to apply for insurance for college students. College students submit a copy of their resident ID card or household registration book, a recent one-inch color photo without a hat, and other relevant information. The college student fills out the insurance registration form and goes through the insurance registration and payment procedures. The university will review the content of the information and make the payment. Basic personal information is entered and summarized, and the basic information, relevant forms and premiums collected are submitted to the Municipal Medical Insurance Center in accordance with regulations. The Fuzhou Medical Insurance Center verifies the personal information and imports it into the system to check the payment status. The Fuzhou Medical Insurance Center produces a college student medical insurance card and submits it to each university for distribution to insured college students. 4. The basic medical insurance payment standard for college students is per person per year for college students in Rong University. The medical insurance financing level is 120 yuan. Among them, the individual payment is 40 yuan and the government subsidy is 80 yuan. The individual tuition fees paid by students from families with financial difficulties will be subsidized by the same level of finance in accordance with the affiliation of the university. 5. Medical security benefits for college students. The medical expenses incurred by college students for hospitalization and outpatient serious illness shall be paid by the medical insurance fund. The minimum payment standard, maximum payment limit and personal sharing ratio shall be implemented in accordance with the corresponding standards for primary and secondary school students participating in the city's urban resident basic medical insurance. (1) Payment method for outpatient serious illness and hospitalization medical insurance pooling fund 1. Deductible payment standards for outpatient serious illness and first hospitalization (the "threshold" for the pooling fund to start payment): Medical institutions insured persons in the top three (excluding specialists), top three, and bottom two As well as second-level and second-level junior college students, first-level community health service centers, and township health centers: 400 yuan, 200 yuan, 150 yuan, and 75 yuan for college students. Multiple hospitalizations within the year will be reduced by 100 yuan according to the above minimum payment standards until it drops to zero. Two or more major outpatient diseases are calculated based on one minimum payment standard. 2. The payment ratio of the overall pooling fund (the payment ratio of the medical insurance pooling fund after the starting payment standard of the pooling fund and before the cap line): the insured persons of medical institutions are the top three (excluding specialists), the top three, the top two, and the top two and above specialists are the top two and one. Level community health service center, township health center college students 60%70%75%80%3. Cap line: The maximum payment limit of the overall fund within the year (January 1st to December 31st) is 60,000 yuan (including the minimum payment standard, The personal burden of medical expenses within the scope of the basic medical insurance catalog). (2) Compensation method for student accidental injury insurance: After enrolling in the insurance, students at school can enjoy supplementary accidental injury insurance for non-disease injuries caused by sudden, external, unintentional accidents and natural disasters. The specific compensation standards are as follows: 1. 95% of the reasonable and necessary emergency ambulance fees incurred in hospital (emergency) clinics due to accidental injuries, and medical expenses that are within the scope of the "Three Catalogs" of Fuzhou Resident Medical Insurance compensation. The annual compensation limit is 5,000 yuan. 2. If you suffer accidental injuries resulting in disability or burns, you will be responsible for paying insurance benefits according to the degree of disability, with the maximum compensation amount being 15,000 yuan; 3. If you suffer accidental injuries that result in death, the accidental injury death insurance benefit will be 15,000 yuan. If a student encounters an accident, he or she should report it to the insurance company within 3 days after becoming aware of the accident. The reporting hotline is: 83327551.

6. Major illnesses and treatment items in outpatient clinics for college students (1) Chemotherapy and radiotherapy for malignant tumors; (2) Dialysis for severe uremia; (3) Anti-rejection treatment after organ transplantation; (4) Schizophrenia; (5) Regeneration Obstructive anemia; (6) Diabetes; (7) Hypertension; (8) Hemophilia; (9) Outpatient critical illness rescue; (10) Epilepsy; (11) Systemic lupus erythematosus; (12) Bronchial asthma 7. Confirmation of serious illnesses and treatment items in outpatient clinics for college students There are two steps to confirm serious illnesses and treatment items in outpatient clinics: First, a physician or above from the deputy director or above of the relevant specialty of a comprehensive hospital or specialist hospital designated by the second-level medical insurance or above shall make a clinical diagnosis and fill out the " Fuzhou Urban Resident Basic Medical Insurance Outpatient Serious Illness and Treatment Items Confirmation Form" shall be submitted to the medical insurance department of the medical institution for confirmation and stamping; second, the insured patient (or his family member) shall hold the "Confirmation Form" and the medical records and medical insurance card of the selected hospital. Go to the medical insurance center to confirm the registration. 8. Incentive Mechanism for Continuous Participation If a person participates in resident medical insurance and participates in continuous insurance for one full year, the payment ratio of the medical insurance pooling fund will be increased by 1 percentage point based on the payment ratio of the previous year, and the cumulative increase will not exceed 5 percentage points when first participating in the insurance. 9. Expenses that the University Student Medical Insurance Co-ordination Fund will not pay. The Medical Insurance Co-ordination Fund will not pay for the following expenses: 1. Medical expenses for treatment at non-designated medical institutions (except for rescue); 2. Injuries caused by traffic accidents, medical accidents or other liability accidents Medical expenses; 3. Medical expenses for injuries caused by drug abuse, fights, violations, etc.; 4. Treatment expenses for self-injury, self-mutilation, alcoholism, drug rehabilitation, sexually transmitted diseases, etc.; 5. Cosmetology, orthopedics, The cost of treatment for physiological defects; 6. Medical expenses for seeking medical treatment outside without approval; 7. Expenses paid by other insurance types, commercial insurance, third-party responsible parties, etc.; 8. National, provincial and municipal medical insurance policies. Other expenses that are not payable. 10. How to handle hospitalization? If college students need to be hospitalized due to their illness, they should go to the school hospital (clinic) of the school with their medical insurance card, student ID card or resident ID card to go through the hospitalization procedures. Those who can be treated in the school hospital will be hospitalized; the school hospital does not have the capacity. Treatment should be transferred to designated medical institutions in the coordinating area, but the school hospital (clinic) must register and report to the Fuzhou Medical Insurance Management Center. If the disease cannot be treated by the highest medical institution in the coordinated area and needs to be transferred to a hospital outside the coordinated area for treatment, it must be consulted by experts from a provincial general hospital or a specialized hospital at or above the municipal level designated by the medical insurance to confirm that it is necessary to transfer to an out-of-town hospital for treatment and go through relevant procedures. Report to the Medical Insurance Management Center for approval. 11. How to reimburse medical expenses and procedures for medical treatment in other places? If college students live outside the coordinating area during holidays, school breaks, and during educational internships, project research, social surveys, etc. specified by the school, and need hospitalization or outpatient treatment for serious illnesses, they should contact the medical insurance agency through the college student medical security management department of the school. The institution shall be registered and filed, and the medical insurance designated medical institution in the place of residence shall be selected for medical treatment. The medical expenses incurred shall be paid in full by the individual first, and the reimbursement procedures shall be completed after the medical treatment is completed. If it is necessary to transfer for medical treatment outside the coordinating area, the consultation opinion of the chief physician of a provincial level three or above medical institution designated by the medical insurance should be provided. The transferred hospital will stamp it and send it to the medical insurance center for review and filing. The fee will be paid in full by the school or the student himself. After the medical treatment, present 1. Medical insurance card; 2. Expense receipts and lists (stamped with the official seal of the hospital or charge seal); 3. Hospital chief, short medical orders and discharge summary (copies stamped with the official seal of the hospital); 4. Hospitalization verification Form; 5. Go to the Municipal Medical Insurance Center to handle the reimbursement procedures using your Agricultural Bank of China settlement account. 12. The settlement year of basic medical insurance for college students. The settlement year for basic medical insurance for college students is from January 1 to December 31. Freshmen who have participated in the Urban Resident Basic Medical Insurance or New Rural Cooperative Medical Care in the place where their household registration is located before enrolling can continue to enjoy the corresponding benefits in the original insured (participating) place during the insurance period of the current year; freshmen who participate in the Basic Medical Insurance for College Students in the year of enrollment can continue to enjoy Pay the basic medical insurance premiums from September to December of that year as required and enjoy the corresponding basic medical insurance benefits. Insured college students who graduate, graduate, drop out of college, or have their student status canceled according to student status management regulations will still enjoy the basic medical insurance benefits for college students during the insurance period in the year when they go through the formalities for leaving school. Insured college students who go through the suspension of study procedures in accordance with the student status management regulations will continue to enjoy the basic medical insurance benefits for college students during the suspension of study. 13. Give an example of the calculation of medical insurance fund payment when insured college students are hospitalized. When insured college students are hospitalized, they settle medical expenses with designated medical institutions by swiping their medical insurance cards.

Assuming that Xiao Li, an insured college student, is hospitalized in Fuzhou No. 1 Hospital for the first time this year, his medical expenses will total 7,650 yuan, of which 7,380 yuan will be covered by the medical insurance catalog. Because when college students are hospitalized in a triple-B hospital, the minimum payment standard for the medical insurance pooling fund is 200 yuan, and the payment ratio is 70%. Therefore, the amount paid by the medical insurance pooling fund when Xiao Li is discharged from the hospital is: (7380-200) × 70% = 5026 yuan.

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