I would like to ask why rural medical insurance does not provide reimbursement?

1. Failure to seek medical treatment in a designated medical institution. Some farmers may not know much about it, but some policies for social security reimbursement in China stipulate that medical treatment must be made in designated hospitals before reimbursement can be made. Therefore, farmers should have an understanding of their designated medical institutions when handling the payment.

If you need to transfer to a higher hospital due to limited conditions, you also need to go through the transfer procedures, and there is no way to reimburse without the transfer procedures.

2. Transfer to the hospital without approval**. This is the same as the previous article, if you need to go to a better hospital for **, then you must go through the procedures for transferring to the hospital! Only with the approval of the transfer can the reimbursement criteria be met, otherwise the expenses after the transfer will be borne by yourself.

3. Reimbursement overtime. You must know that there is also a certain time limit for reimbursement, so everyone should try to reimburse it as soon as possible, because according to the regulations, if the hospitalization expenses are more than 1 year, there is no way to reimburse them. If you are seeking medical treatment in other places, you need to complete the reimbursement procedures within 3 months, otherwise there is no way to reimburse.

4. Medical treatment for special accidents. For example, personal drunk driving.

Medical treatment that causes special accidents such as traffic accidents, miscarriages, abortions, and plastic surgeries is not reimbursable because of personal reasons.

For rural medical insurance, there is no reimbursement now, in fact, it feels updated now, so it cannot be reported for the time being, and the system has returned to normal. You can apply for this kind of medical insurance.

Rural medical insurance hospitalization is reimbursed, if you are hospitalized in the hospital designated by your medical insurance card, it is about 80% reimbursement, if you are hospitalized in a hospital designated by the non-medical insurance card, go to the hall of the medical insurance center where the medical insurance card is located to go through the filing and referral procedures before hospitalization, and the hospitalization can be reimbursed.

This is going to ask the social security settlement window of the hospital, and I don't know what is your reason?

Medical insurance will also be reimbursed, as long as it is within the scope of medical treatment, it will be reimbursed!

Rural cooperative medical care is a major measure taken by the state to solve the problem of expensive and difficult medical treatment for farmers. The introduction of the cooperative medical care policy has to a great extent solved the problem of difficulty in seeing a doctor, and has given the peasants a "reassurance" and no longer worries about the high medical expenses.

Rural cooperative medical care is raised through farmers' contributions, collectives and ** contributions, and after the funds are concentrated, they will be earmarked for the villagers' sick hospitalization, which is what people usually call reimbursement. With the improvement of living standards, the payment and reimbursement amount of rural cooperative medical care is also increasing, which is undoubtedly a good thing for farmers, take 2017 as an example, farmers only need to pay 150 yuan per capita, but the reimbursement amount can reach up to 80%, that is, the reimbursement ratio in provincial hospitals is also as high as 60%, such as serious illness will have serious illness assistance.

Rural cooperative medical care does have many benefits and brings real benefits to the people, but there are also several situations that are not included in the reimbursement and cannot enjoy the cooperative medical policy.

1. Medical expenses caused by fighting, alcoholism or suicide are not reimbursed, and car accidents and work-related injuries are compensated by a third party, and are not covered by rural cooperative medical reimbursement.

2. In the process, hospitalization expenses, food expenses, nutrition expenses, special care expenses, etc. cannot be reimbursed, and blood transfusion expenses cannot be reimbursed.

3. Rural cooperative medical care is a designated hospital for treatment, if you need to transfer to the hospital, you need to agree to the designated hospital and issue a corresponding referral form, so self-medical treatment or self-purchased drugs can not be reimbursed.

4. The expenses incurred by plastic surgery, dental prosthesis, prosthesis, organ transplantation, etc. cannot be reimbursed, and the part exceeding the reimbursement limit will not be reimbursed.

Rural medical insurance can be reimbursed in the process of medical treatment, but if there is a special disease or has participated in other reimbursements, it is likely that it will not be reimbursed.

Rural medical insurance cannot be reimbursed without paying money, rural medical insurance is paid for one year and guaranteed for one year, for example, if you don't pay in 2021, then you can't use it in 2022.

There is a third-party liability, the relevant procedures of medical insurance are not followed for the first time, the hospital does not meet the relevant regulations on reimbursement, and the relevant reimbursement of Class B drugs cannot be reimbursed; Because such a situation does not meet the reimbursement conditions of rural medical insurance.

Legal analysis: 1. Failure to reimburse within the specified time: The current reimbursement system can only reimburse the medical expenses of the current year in the current year, and the expiration is regarded as invalid, if it is in the field for medical treatment, it needs to be reimbursed within half a year, but we may not delay this matter for too long, after all, the current reimbursement process is also more convenient.

2. There is a compensation unit or individual: If the medical expenses are compensated by others or units due to the injury in the line of duty, this situation will not be reimbursed, but the specific situation can of course be reported according to oneself, and everyone knows these things very well. 3. Medical expenses caused by illegal acts:

For example, injuries caused by theft, drunk driving, and brawls are not covered by all medical expenses. 4. Medical expenses incurred due to non-disease reasons: such as plastic surgery, **, beauty, etc., medical expenses not caused by diseases will not be reimbursed.

5. Subjective causes of miscarriage, medical expenses arising from abortion. Sixth, the medical institution is not a designated unit: to participate in the rural cooperative medical insurance should adopt the principle of proximity, if in the field of medical treatment, back to the local reimbursement is not in line with the regulations, the local medical institutions need to be transferred when the level of local medical institutions is limited, but also to issue a hospital transfer certificate, in order to smooth reimbursement.

Legal basis: Social Insurance Law of the People's Republic of China

Article 2: The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Article 17 If an individual participating in the basic endowment insurance dies due to illness or non-work-related reasons, his surviving family members may receive funeral subsidies and pensions; Those who completely lose their ability to work due to illness or non-work-related disability when they have not reached the statutory retirement age may receive sickness and disability allowance. The required funds are paid from the basic pension insurance**.

Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with the provisions of the State.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

If there is no medical insurance in the countryside, then if you are hospitalized**, all the medical expenses will not be reimbursed, and the medical insurance purchased in the rural areas is the New Rural Cooperative Medical System.

Medical insurance, this kind of medical insurance is generally purchased once a year, after the purchase can enjoy the medical expense reimbursement treatment, so for rural people, must not save a little money without buying the new rural cooperative medical insurance, once sick and hospitalized, it is not a small expense, many families simply can not afford it, so we must buy medical insurance in time.

Medical insurance includes medical insurance for urban employees.

and the new rural cooperative medical insurance, after purchasing medical insurance, we can be reimbursed a lot of expenses when we are sick and hospitalized, and these expenses are borne by the state, so medical insurance.

For ordinary citizens, it is also a kind of welfare, especially after employees join the enterprise, the company must be required to pay employee insurance as soon as possible, because after paying can enjoy the medical insurance reimbursement treatment, and the first department also stipulates that the enterprise should buy five insurances and one housing fund for the employees who have joined the company.

If the worker finds that the enterprise has not purchased, he can also ask the enterprise to make up the payment.

If you want to enjoy lifelong hospitalization expense reimbursement after retirement, then the medical insurance paid must exceed the minimum number of years, generally 20 years for women, 25 years for men, if you retire, you can choose to pay a lump sum then you can enjoy the treatment of medical expense reimbursement after retirement. If you find that you have not purchased employee insurance, then you should buy the new rural cooperative medical insurance in time, but the reimbursement ratio is a little lower than that of employee medical insurance.

Most medical insurance plans normally only cover after hospitalization, while general outpatient expenses are not. Although the reimbursement ratio of NCMS insurance is a little lower than that of employee insurance, a person in rural medical insurance only needs to pay more than 100 yuan a year to enjoy the treatment of medical expense reimbursement, and it is precisely because of the strength of the country that every citizen can enjoy the treatment of medical insurance.

You can choose to go to the insurance company for reimbursement, as long as you buy insurance, you can go to the insurance company and let the insurance company reimburse you according to your situation.

If you participate in the NCMS medical insurance, you can be reimbursed, but if you don't participate in anything, you can't be reimbursed, you can only pay for yourself.

It cannot be reimbursed, and it cannot be reimbursed if you do not purchase medical insurance, and you can buy NCMS.

As long as you purchase cooperative medical care, you can be reimbursed.

You must go to a designated medical institution for medical treatment to enjoy reimbursement.

Rural cooperative medical insurance is purchased in the current year and takes effect in the following year to enjoy reimbursement treatment, and its minimum fee is 20 yuan per person.

Reimbursement by cooperative medical insurance needs to be made at the medical insurance settlement window of the local cooperative medical management institution or designated medical institution.

The procedures include: ID card, medical insurance card, original invoice, medication list, medical record and other materials.

The reimbursement of cooperative medical insurance is carried out on a pro-rata basis, generally fluctuating around 20-85%. The proportion and amount of reimbursement are related to their own examinations and medications, medical level and other factors. For example, it is relatively clear that Class A drugs can enjoy full coverage, Class C needs to bear all the out-of-pocket costs, and Class B reports 80% and 20% of the cost.

A person has used up a total of 19,000 yuan in medical expenses, and the reimbursement formula is like this: (19,000-500 "starting line" - self-financed drugs) * 70%, if self-financed drugs account for a large proportion, there is not much reimbursement for them.

1. The vast majority of diseases can be reimbursed, (you can do this) but there are many restrictions on medication and ** items. At the same time, if equipment is needed, it is usually not reimbursed. (e.g. brackets or something).

2. Accident insurance obviously cannot reimburse this. Reimbursement will only be made if the injury you receive has caused permanent damage to you and may affect your life. (It's not up to you to decide this, the insurance company has a strict disability definition table, which is judged according to that **.) ）

Supplement: It can be reported at the same time. Accidental injuries belong to commercial insurance, and cooperative medical care belongs to social security, which is not in conflict and can be reported at the same time.

But there is a strict definition of unintentional injury. There is a difference between the cost of any injury that we usually understand as an accident.

Accidental injuries in commercial insurance are essentially those that are irreparable loss or loss of ability due to accidents.

Your situation clearly does not fall into this category. Unless the doctor says that your leg is not cured and you can only walk on crutches in the future, then the insurance company will pay for it. If the doctor says it can be cured, then it is not an accidental injury.

3. The vast majority of diseases can be reported, except for work-related injuries, fights, brawls, intentional self-injury and self-injury, accidental injuries with third-party liability, cosmetology, surgical orthopedics, etc. Specifically, according to the local rural cooperative medical regulations.

4. The compensation of commercial accident insurance shall be paid according to the terms of the contract, but there is one point, the medical expenses cannot be reimbursed repeatedly, and only one party can be selected to report.

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