Reimbursement ratio of Nanjing university students' medical insurance

The fund pays 85% of the medical expenses incurred in outpatient clinics.

1. Participating students who register at the university hospital with their campus cards will pay 30% of the medical fees eligible for reimbursement.

2. 50% of outpatient medical fees for acute medical emergencies or outpatient medical expenses referred from the university hospital to an off-campus linked hospital due to the limitations of the university hospital (the validity period of the referral for the same medical condition is one month) shall be reimbursed to those who are eligible for reimbursement of the university's publicly-funded medical expenses (the maximum limit of reimbursement is 2,000 yuan per year). Outpatient and emergency medical expenses incurred without referral from the University Hospital or in other non-linked hospitals will not be reimbursed. (Note: The outpatient and emergency room visits to other hospitals are self-paying and do not require a social security card.)

3. Outpatient medical fees for accidental injuries (traumas, bone fractures, etc.), which are eligible for reimbursement by the school's public health care system, will be reimbursed at 30% of the cost at the school hospital, 50% at the linked hospitals outside the school, and 30% at the unlinked hospitals, up to the maximum of RMB 2,000 yuan per year.

4. Maternity: In accordance with the regulations on family planning, prenatal checkups will be reimbursed at 50%, with a maximum reimbursement limit of 300 RMB; before hospital delivery, you need to go to the hospital where the delivery takes place to apply for maternity registration, which will be carried out in accordance with the relevant policies of the Municipal Health Insurance Center, and will be billed directly with the social security card.

5. Outpatient major diseases (including malignant tumors, hemodialysis (including peritoneal dialysis) treatment for severe uremia, anti-rejection treatment after organ transplantation, hemophilia, aplastic anemia disorders, systemic lupus erythematosus) and outpatient psychiatric disorders (schizophrenia, schizoaffective disorder, paranoid psychosis, bipolar disorder, epileptic psychosis, mental retardation accompanied by mental retardation), depressive episodes (moderate or severe), and psychotic episodes (moderate or severe). , depressive episodes (moderate and severe), and obsessive-compulsive disorder), the insured students shall apply for the recognition at the tertiary designated medical institutions or specialized hospitals with the qualification of recognizing the diseases in the city and have the recognition of the diseases audited by the medical insurance office of the hospital. The outpatient major diseases also need to go to the nearest district social security office to print the "Special Medical Record for Outpatient Major Diseases" after the audit. When you visit the social security card and the "outpatient certificate of major diseases" to the designated a medical institution, medical insurance coverage of medical expenses, medical insurance fund to pay 85%.

Legal basis

The People's Republic of China Social Insurance Law

Article 25 The State establishes and improves the basic medical insurance system for urban residents.

Basic medical insurance for urban residents is a combination of individual contributions and government subsidies.

The government shall subsidize the part of individual contributions required by those who are entitled to the minimum subsistence guarantee, persons with disabilities who have lost their ability to work, and elderly persons and minors over sixty years of age from low-income families.