2. Legal basis: Article 28 of the "Social Insurance Law of the People's Republic of China"
Medical treatment that complies with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards and emergency rescue The cost is paid by the basic medical insurance fund in accordance with national regulations.
Second, can outpatient clinics in other places be reimbursed?
Off-site outpatient visits can be reimbursed. People who live in other places for a long time and meet the requirements of the insured place need to apply for a record of relocation in the insured place, receive hospitalization in a hospital that is included in the out-of-town medical settlement system, and use their new social security card to directly settle medical expenses. According to legal provisions, the part of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and drug operating units. Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue services in accordance with the law shall be paid by the basic medical insurance fund in accordance with national regulations.
Answered in July 2022-12
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Can rural cooperative medical outpatient clinics be reimbursed?
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Can the rural cooperative medical system reimburse outpatient expenses?
Rural cooperative clinics can be reimbursed. Medical insurance policy: New rural cooperative medical care outpatient services can be reimbursed, including reimbursement for drug purchases.
As long as the purchased medicine supports reimbursement, it will generally be reimbursed. The scope of reimbursement mainly includes drug reimbursement, examination fee reimbursement, and bed fee reimbursement. The new rural cooperative medical system (hereinafter referred to as "New Rural Cooperative Medical System") refers to a medical mutual aid system for farmers that is organized, guided and supported by the government, farmers voluntarily participate, and individuals, collectives and the government jointly raise funds. It raises funds in the form of individual donations, collective support and government funding. The new rural cooperative medical system is a mutual-aid medical economic system for farmers that focuses on overall planning of major illnesses and compensation for minor illnesses. This definition shows that the New Rural Cooperative Medical System helps farmers with their medical expenses for diseases, but outpatient services, falls, and injuries are not covered by this insurance. As a form 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 critical illness insurance should be connected with urban residents’ medical insurance and new rural cooperative medical insurance. Urban residents' medical insurance and the new rural cooperative medical system should provide basic medical security in accordance with policies. On this basis, critical illness insurance mainly protects urban residents’ compliant medical expenses after being compensated by medical insurance and New Rural Cooperative Medical Insurance when the insured (co-insured) suffers from a serious illness and the medical expenses are high. High medical expenses can be determined based on the criterion that the individual's cumulative annual compliant medical expenses exceed the annual per capita disposable income of urban residents and the annual per capita net income of rural residents published by the local statistics department. The specific amount is determined by local governments. Compliant medical expenses refer to actual and reasonable medical expenses (which may be stipulated not to be paid), and are determined by the local government. Various localities can also launch critical illness insurance starting from diseases with a heavier personal burden. Can the rural cooperative medical system reimburse outpatient expenses? Rural cooperative medical card outpatient services can be reimbursed. The new rural cooperative medical clinic, also known as the new rural cooperative medical system, refers to a mutual aid system for farmers under the organization, guidance and support of the government, in which farmers voluntarily participate, individuals raise funds, and the collective and the government adopt a variety of methods to coordinate serious illnesses. Raising funds requires individual donations, collective support and government contributions. In summary, rural cooperative medical outpatient services are reimbursable. Rural cooperative medical care is a kind of insurance that many rural people participate in and has certain benefits. Rural cooperative medical care means that under 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 the People's Republic of China" complies with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, and shall be paid from the basic medical insurance fund in accordance with national regulations.
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