School health insurance reimbursement process

School health insurance reimbursement process: students' outpatient expenses will be reimbursed according to the proportion of the school hospital's referral form and the fee bill of the designated hospital; accidental injury outpatient clinic needs to provide the accidental injuries; outpatient special diseases in accordance with the implementation of the relevant management methods. Hospitalization expenses are divided into two cases: before and after the completion of insurance procedures. Individuals who are hospitalized in a different place are required to pay the full amount in advance and provide relevant materials to the Social Security Bureau for settlement of expenses. Some medical expenses are not covered by basic medical insurance, such as consultation at non-designated medical institutions, self-inflicted injuries, and cosmetic orthopedics. Traffic accident medical fees can be included in the basic medical insurance payment scope.

School medical insurance reimbursement process:

1. General outpatient clinic

The first hospital where the insured students go for medical treatment (except for emergency rescue) is in the school hospital, and the outpatient expenses incurred are paid in accordance with the above ratio. Students who are diagnosed by the doctor of the school hospital and need to be transferred to another hospital for treatment will be referred to the designated hospital by the doctor of the first hospital.

The outpatient medical fees incurred will be paid in full by the individual first, and then reimbursed to the Accounting and Finance Office of the university within 3 months with the referral order of the university hospital, valid bills from the designated hospital, prescription list, and one-card (or student ID card) until the university hospital checks and signs the order.

The outpatient medical expenses incurred by students during their off-campus internships for acute illnesses at the social security designated medical institutions in the internship site that are covered by basic medical insurance will be reimbursed in the way of "off-campus referrals", while medical expenses incurred due to chronic illnesses will not be reimbursed.

Outpatient medical fees incurred during summer and winter vacations and when leaving the university on weekdays are not reimbursed.

2. Accidental Injury Outpatient Clinic

Students who seek medical treatment outside of the university, within 3 months after the completion of the treatment, shall be reimbursed by the University Finance Office with the official seal of the university, the referral form of the university hospital, the valid charges of the designated hospital, the prescription form, and the student ID card (or the one-card pass), etc. after reviewing and signing the form at the university hospital.

3. Outpatient Special Diseases

The management of outpatient special diseases and the settlement of expenses shall be carried out according to the Measures for the Management of Outpatient Special Diseases of Basic Medical Insurance.

The process of applying for reimbursement for student health insurance usually includes the following steps: first, students need to register for health insurance at the school medical office or relevant departments, providing basic personal information and health insurance card and other relevant information. Next, students need to choose a partner hospital or medical institution for medical treatment and present a valid health insurance card at the time of treatment. The hospital will issue a list of medical expenses based on the consultation and treatment, and students should keep the relevant invoices and receipts. Then, the student will fill in the application form for reimbursement of medical insurance, attach the invoice and the list of expenses, and submit it to the medical department of the school within the specified time. The medical department will review the application materials and submit those that meet the requirements to the health insurance organization for reimbursement. Finally, the medical insurance organization will verify the application materials and make reimbursement according to the stipulated percentage, and transfer the reimbursement directly to the student's personal medical insurance account or refund it directly to the student. Students can check their personal health insurance account or consult with the health insurance organization to find out the progress and exact amount of reimbursement. Please note that the specific reimbursement process may vary from region to region and from school to school, so students are advised to communicate with their school's medical department in a timely manner.

In summary: According to the regulations of student health insurance, there are different processes for reimbursement of outpatient expenses and inpatient expenses. For outpatient expenses, students need to pay the full amount first, and then go to the school hospital with the school hospital referral form, the fixed hospital fee bill and other materials to review and sign, and finally to the school finance office for reimbursement. For hospitalization expenses, if the insurance procedures have not been completed, students need to pay the full amount of the expenses by themselves and reimburse them to the social security bureau after getting the social security card; if the insurance procedures have been completed, students only need to go to the designated medical institutions for hospitalization by presenting the social security card, and the social security bureau will settle the bill with the medical institutions directly. Expenses for hospitalization in other places need to be paid in full by the individual, and the expenses will be settled at the Social Security Bureau within a certain period of time with the relevant documents after discharge from the hospital. Students are reminded that the specific reimbursement process may vary depending on the region and the school, and are advised to communicate with and learn from their school's medical department in a timely manner.

Legal basis:

The full text of the Social Insurance Law of the People's Republic of China

Article 28

Medical expenses that are in accordance with the drug list, diagnostic and therapeutic items, and standards of medical service facilities of the basic medical insurance as well as those of the emergency and rescue shall be paid out of the basic medical insurance fund in accordance with the state regulations.