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Reimbursement Process and Regulations for Student Medical Insurance

The insured is admitted to hospital → Check-in at the local designated health care organization (present admission notice, medical insurance card, Identity card) → Admission to hospital → Check-in for Treatment →payment of hospitalization (the insured who meet the discharge standard can settle the medical bill with discharge notice and medical insurance card) → Discharge from hospital

I. Regulations for payment

1.In hospitalization fee, patients are responsible for the following expenses:

(1) Out-of-pocket expense

(2) Paid in advance by patients (Drugs that covered by medical insurance, treatment programs, the insured need to pay a portion of expenses within the three medical insurance service facility directories.

(3)Expenses that below the medical insurance pay line

(4)Out-of-pocket expenses in copayment

(5)Exceed the limit of medical allowance for critical illness.

2. The medical insurance pay line for each time

Classification of Hospitals

Serving Staff

Retired Staff

Primary Hospital

RMB 500

RMB 350

Secondary Hospital

RMB 1000

RMB 700

Tertiary Hospital

RMB 2000

RMB 1400

3.Payment portions in copayment

Classification of Hospitals

Serving Staff

Retired Staff

Payment of pooling fund

Individual payment

Payment of pooling fund

Individual payment

Primary Hospital

90%

10%

93%

7%

Secondary Hospital

85%

15%

89.5%

10.5%

Tertiary Hospital

80%

20%

86%

14%

4. Maximum payment limit for pooling fund

The total maximum payment limit within one social security fiscal year is four times the average income of local staff in last fiscal year (RMB 40,187 for 2007)(cap line is RMB160,748 for 2008).

5.Medical allowance for critical illness

Application is not required to receive medical allowance for critical illness. When the basic medical pooling fund payment is over the maximum payment limit of one fiscal year, the 95% of the basic fee of hospitalization and specialized items in clinic that will be paid by critical illness allowance. The basic fee for chronic disease will be paid by critical illness allowance under the payment standard, the maximum payment will be 150 thousand Yuan.

6.Payment standard for supplementary medical insurance

For the people who receive supplementary medical insurance and basic medical insurance for hospitalization and clinic specialized items, supplementary medical insurance will pay 70% of the exceeding balance of the total cost over 2000 Yuan, if the correspondent medical expenses by individual is under the medical cost of social pool maximum limit within one fiscal year (excluding individual should pay for part of the expenses according to “three directories”).

7.Hospital bed fee per day according to the following criteria

Classification of Hospitals

General Ward

ICU

Laminar Flow Ward

Clinic (Emergency) Observation

Primary Hospital

RMB 29.6

RMB 56

RMB 224


Secondary Hospital

RMB 33.3

RMB 63

RMB 252

RMB 9

Tertiary Hospital

RMB 37

RMB 70

RMB 280

RMB 10

2.In following situations, reimbursement for small amount of medical expenses can be applied at Guangzhou Medical Insurance Service and Management Center (following referred as City Medical Insurance Center):

2.1.Basic medical expenses in designated hospital in other regions with effective application for accessing medical service in other regions;

2.2.Basic medical expenses in designated health care organization in out of pooling areas within China during business trip, government-sponsored study and home leaves.

(三)Note

1.The insured is required to present the medical insurance card and identity card for admission of hospital.

2.According to condition needs, patient who meet the admission standard can be readmitted to hospital without waiting for 15 days.

3.Hospitalized for treatment continuously over 90 days, the expenses at pay line standard need to be paid again. If it’s hospitalized for treatment at specialist hospital for mental disorder, tuberculosis, the expenses at pay line standard need to be paid again in every 180 days.

4.After treatment, patient who meets the discharging standard is responsible for any cost from the discharging date that is advised by the designated hospital.


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