Can the community-run medical insurance be reimbursed? How can you report it? What is the use of community medical insurance? Can I only report to the hospital?

After the insured residents are hospitalized, they shall pay a certain fee in advance (including Qifubiaozhun and personal out-of-pocket deposit), and the designated medical institutions shall determine the overall payment part and the personal payment part at the time of discharge.

Emergency hospitalization expenses incurred by insured residents in different places due to family visits, vacations and other reasons are included in the scope of medical insurance fund payment. When reimbursing, you need to provide the discharge summary, the first page of medical records, copies of long-term and temporary doctor's orders, hospitalization expenses list, hospitalization documents, disease diagnosis certificate and hospital grade certificate.

Community medical insurance belongs to urban residents' medical insurance, that is, people who can't participate in employee medical insurance (general medical insurance) in urban hukou pay less, but the reimbursement ratio and total reimbursement amount are not as high as employee medical insurance.

Moreover, when seeking medical treatment, you must start from a community hospital, and you can go to a big hospital only if you meet the conditions for transfer. If you go directly to a big hospital, you may not be reimbursed.

Medical expenses incurred by insured residents in hospitalization (including family beds) in designated medical institutions shall be subject to certain Qifubiaozhun, and the part exceeding Qifubiaozhun shall be paid according to the control method of hospitalization ratio and maximum payment limit.

Second-class outpatient serious illness expenses can be reimbursed.

According to reports, serious outpatient diseases include: special outpatient diseases (radiotherapy and chemotherapy for malignant tumors, outpatient renal dialysis, taking anti-rejection drugs after organ transplantation) and chronic diseases (hypertension, coronary heart disease, diabetes).

Outpatient treatment of special diseases: 50% from the overall fund and 50% from individuals; Outpatient treatment of chronic diseases: In one year, if the medical expenses for outpatient treatment of chronic diseases in designated medical institutions exceed 350 yuan, the excess will be paid by the overall fund according to the standard of 50%, and the maximum payment limit of the overall fund is 2,000 yuan.

Criteria for non-reimbursement of community medical insurance:

1. Medical expenses incurred in non-designated medical institutions without approval;

2. Suicide and self-mutilation (except mental illness);

3. Fighting, fighting, alcoholism, drug abuse and other injuries cause crimes or violate the Public Security Administration Punishment Law;

4. Traffic accidents, accidental injuries, medical accidents, etc.

5. Being treated for beauty, plastic surgery, physical defects, etc.

6. Belonging to the scope of industrial injury insurance (including occupational diseases) or maternity insurance payment;

7. Other non-payment circumstances stipulated by the national and provincial medical insurance policies.

Reference link: Baidu Encyclopedia-Community Medical Insurance