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.