Reimbursement Scope of Shanghai University Students' Medical Insurance

Shanghai university students' medical insurance reimbursement scope includes on-campus outpatient and off-campus outpatient emergency treatment.

On-campus outpatient medical expenses will be paid by each institution at no less than 90%, and the rest will be borne by the individual. Off-campus outpatient and emergency medical expenses are paid in accordance with the outpatient and emergency treatment for primary and secondary school students covered by the residence insurance, as follows: outpatient and emergency medical expenses have a starting line of 300 yuan, and individuals are responsible for the portion of the yearly total that exceeds the starting line. Medical expenses for hospitalization and emergency observation are also paid according to this standard.

Scope of use of the medical insurance card:

1, the insured workers in the designated hospitals, pharmacies, medicine purchase, with the password in the POS machine swipe the card to use, but can not withdraw cash or transfer to use. The same applies to the use of the urban health insurance card and the use of the rural health insurance card.

2, designated pharmacies: by the individual account and the integrated account of the two accounts composed of health insurance, the individual account can be used to buy medicines in designated pharmacies, mainly responsible for personal out-of-pocket part of the payment of outpatient expenses and hospitalization costs. The integrated account managed by the medical insurance center pays for the expenses incurred by the insured person in accordance with the local medical insurance reimbursement;

3. Designated hospitals: When you present your medical insurance card to prove your identity and registration at a designated hospital, you do not need to pay for the reimbursement, and you can directly settle the reimbursed part of the medical insurance by the medical insurance and the hospital, and the out-of-pocket portion of the reimbursement can be settled by the medical insurance balance or cash payment. The only part of the out-of-pocket payment will be made by you with your card balance or cash at the checkout.

The reimbursement process for individuals who have paid for health insurance is generally as follows:

1. Seeing a doctor: When visiting a medical institution or purchasing medicines, you need to show your health insurance card and ID card;

2. Preparing reimbursement materials: At the end of the visit, you need to ask the medical institution for diagnostic and treatment records, doctor's orders, prescriptions, receipts and other related materials, and at the same time, fill in the reimbursement application form.

3. Submission of reimbursement application: Submit the prepared reimbursement materials and application forms to the local social security bureau or medical insurance center for reimbursement application. You can also choose to apply for reimbursement online;

4. Review of reimbursement application: The local social security bureau or medical insurance center will review the submitted reimbursement application, and the reimbursement will be credited to the individual's bank account after the review is approved.

In summary, health insurance policies and reimbursement rates may vary from region to region, and local policies should prevail. At the same time, the scope and amount of payment by the medical insurance fund are also affected by different policies, and the specific reimbursement rate and amount of reimbursement may also vary depending on the medical items.

Legal basis:

Article 28 of the Social Insurance Law of the People's Republic of China

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

Article 29

The portion of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.