2. Legal basis: Article 28 of People's Republic of China (PRC) Social Insurance Law.
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Second, can out-of-town clinics be reimbursed?
Off-site clinics can be reimbursed. Living in a different place for a long time meets the requirements of the insured place. Such people need to apply for resettlement and filing in the insured place, be hospitalized in a hospital that is included in the settlement system for medical treatment in different places, and directly settle medical expenses with their new social security card. According to the law, the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue according to law shall be paid by the basic medical insurance fund in accordance with state regulations.
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Can rural cooperative medical care reimburse outpatient expenses?
Rural cooperative clinics can be reimbursed. Medical insurance policy: the outpatient service of the new rural cooperative medical system can be reimbursed, including drug purchase reimbursement. As long as the purchase of drugs supports reimbursement, it is generally reimbursed. The scope of reimbursement mainly includes drug reimbursement, examination expense reimbursement and bed expense reimbursement. The new rural cooperative medical system (hereinafter referred to as the "new rural cooperative medical system") refers to the mutual medical assistance system for farmers, which is organized, guided and supported by the government, voluntarily participated by farmers, and jointly funded by individuals, collectives and the government. It takes the form of individual donations, collective support and government funding to raise funds. The new rural cooperative medical system is an economic system of mutual medical care for farmers, which focuses on overall planning of serious diseases and settlement of minor diseases. This definition shows that the new rural cooperative medical system is to help farmers with medical expenses for diseases, but outpatient service, falls and injuries are not covered by this insurance. As a kind of social insurance, the satisfaction of farmers who benefit from the new rural cooperative medical system and taxpayers who receive government subsidies plays an important role in its success. The coverage of serious illness insurance should be connected with urban residents' medical insurance and the new rural cooperative medical system. The medical insurance for urban residents and the new rural cooperative medical system should provide basic medical security according to the policy. On this basis, the major illness insurance mainly guarantees the eligible medical expenses of urban residents compensated by medical insurance and the new rural cooperative medical system when the insured (co-insured) is seriously ill and the medical expenses are high. High medical expenses can be judged by the fact that the accumulated annual compliance medical expenses of individuals exceed the annual per capita disposable income of urban residents and the annual per capita net income of rural residents announced by local statistical departments, and the specific amount is determined by local governments. Compliance medical expenses refer to the actual and reasonable medical expenses (which can be stipulated not to be paid), which are determined by the local government. All localities can also start to carry out serious illness insurance from diseases with heavy personal burden. Can rural cooperative medical care reimburse outpatient expenses? Rural cooperative medical card outpatient service can be reimbursed. The new rural cooperative medical clinic, that is, the new rural cooperative medical system, refers to the system of farmers' mutual assistance and mutual aid under the organization, guidance and support of the government, in which farmers voluntarily participate, individuals raise funds, and the collective and the government take various ways to make overall plans for serious illness. Raising funds requires individual donations, collective support and government donations. To sum up, rural cooperative medical clinics can be reimbursed. Rural cooperative medical care is a kind of insurance. Many rural people participate in it and have certain benefits. Rural cooperative medical care refers to the organization, guidance and support of the government, farmers voluntarily participate, individuals raise funds, and the collective and the government adopt various methods. Legal basis: Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, and shall be paid from the basic medical insurance fund in accordance with state regulations.
Lawyer Liao has been practicing law popularization for 7 years.
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