Is there a provision that rural medical insurance cannot reimburse medical expenses for hospitalizat

No, if the hospital says this to you, it means that your co-management office has a limit on the hospital's repeated hospitalization rate and does not want you to be hospitalized.

Generally speaking, the Joint Management Office will not restrict the patient, but will only restrict the hospital, if the hospital does not allow the patient, just go directly to the Joint Management Office to complain to the hospital and pass the buck to the patient.

If I still need to be hospitalized after being discharged from the town hospital within 1 month for reimbursement and compensation, can I be reimbursed for compensation again?

Can NCMS be reimbursed?

NCMS can be reimbursed twice, as long as the reimbursement limit is not exceeded, hospitalizations that meet the social security reimbursement rules can be reimbursed.

The secondary reimbursement of NCMS refers to the reimbursement of critical illness insurance, and part of the annual payment of NCMS is used for serious illness reimbursement. There is a time limit for reimbursement of NCMS critical illness insurance, generally within 6 months after the end of the insured**, and the relevant materials can be brought to the relevant departments for reimbursement.

What is the secondary reimbursement ratio of NCMS? The rules for the second reimbursement of NCMS are as follows:

1. If the out-of-pocket expenses are 10,000 yuan, 55% can be reimbursed;

2. If the out-of-pocket expenses are 6-100,000 yuan, 60% can be reimbursed;

3. The out-of-pocket expenses are 10-150,000 yuan, and the amount is reimbursed 65%;

4. If the out-of-pocket expenses are more than 150,000 yuan, 70% can be reimbursed.

It should be said that the expenses reimbursed by NCMS for the second time do not include the part that has been reimbursed before. In addition, NCMS can only reimburse medical expenses incurred during the current year.

You are enrolled in the urban residents' medical insurance, which is what we call rural insurance. After participating, as long as you are in the normal insurance status, then you can be young and hospitalized, as long as you give your medical insurance card to the settlement center at the window. Within a month, no matter how many hospitalizations you have, you can be reimbursed on the spot in accordance with the reimbursement policy of medical insurance.

It's just the first time that there is a threshold, and when the hospitalization threshold reaches 600 yuan, it will enter the starting line of medical insurance. The second time is 400 yuan. As long as the medical expenses reach 400 yuan, they can be reimbursed according to the proportion.

As long as the medical devices and drugs used by the doctor do not meet the medical insurance catalog, the part you personally bear will increase rapidly, resulting in a decrease in the reimbursement ratio of medical insurance. Therefore, you must fully negotiate and communicate with the doctor, and be able to use the medical insurance for diagnosis and treatment activities as much as possible, which can effectively reduce your overall medical costs. In addition, if your personal self-excess, which reaches or exceeds 20,000 yuan, it can be accumulated for secondary reimbursement.

More than 20,000 yuan to 50,000 yuan can be reimbursed 50%. Between 50,000 yuan and 100,000 yuan, about 65% can be reimbursed. , which is a cumulative amount over a year, not a single one.

This is the reimbursement policy of agricultural insurance. I hope you can make good use of it, and Changlu can effectively reduce your medical costs. I wish you all the best and a happy family. 

Reimbursement can be made after hospitalization and discharge, and there is no number of days. Information required for the Rural Cooperative Medical Reimbursement Institute: (1) Materials to be brought for outpatient reimbursement:

Outpatient invoices, cooperative medical certificates (or medical records). (2) Hospitalization reimbursement information: hospitalization invoices, cooperative medical certificates (or medical records), expense clearance group celebration forms, discharge summaries and other relevant certificates.

Legal analysis: NCMS can be reimbursed for New Year's Eve, and the hospitalization within 3 months can be reimbursed, and there is a minimum payment line for the second hospitalization within one year. The deduction method of the threshold is as follows:

In the same year, the same disease, in the same medical institution for the second hospitalization, the minimum payment line is reduced by half for the second time; The third hospitalization of the year was halved from the first.

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

Article 24: The State is to establish and improve a new type of rural cooperative medical system.

The management measures for the new type of rural cooperative medical care shall be stipulated by ***.

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 **.

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From a legal point of view, if the interval between the two admissions is not more than 15 days, then the second admission cannot be reimbursed. The insured person can be hospitalized again in a short period of time after being hospitalized due to **, and for the re-hospitalization in a short period of time due to **, the insured person shall provide relevant certificates for hospitalization registration.

Can medical insurance reimburse hospitalization for two hospitalizations for different illnesses within a month?

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From a legal point of view, if the interval between the two admissions is not more than 15 days, then the second admission cannot be reimbursed by the medical and departmental insurance. The insured person Yan Bu can be hospitalized again in a short period of time after he needs to be hospitalized, and for the re-hospitalization in a short period of time after the accident, the insured person shall provide relevant certificates for hospitalization registration.

Legal basis: Article 2 of the Social Insurance Law of the People's Republic of China stipulates that the State shall establish a basic social insurance system such as endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, so as to protect citizens' right to receive material assistance from the state and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc. Article 26 The standards for the treatment of basic medical insurance for workers, the new type of rural cooperative medical care, and the medical and filial piety insurance for urban residents shall be implemented in accordance with state regulations.

Medical insurance can reimburse hospitalization twice a month, and there is no reimbursement threshold for the second hospitalization within 15 days. For the same disease, if the interval between two hospitalizations is less than one month, it will be reimbursed as one hospitalization.

The insured person can be hospitalized again in a short period of time after being hospitalized due to **. For those who are hospitalized again in a short period of time after **, but the last hospitalization expenses have not been settled, the insured person or the agent shall go to the medical department of the hospital where he or she is hospitalized again to go through the hospitalization registration procedures with the social security card or medical insurance card and personal ID card, the hospitalization certificate stamped with the special seal of medical insurance, and the hospitalization expense certificate provided by the hospital provided by the previous hospitalization.

Medical insurance reimbursement restrictions, including two fixed points, three catalogs, minimum payment line, cap line, reimbursement ratio, etc.

1.Two fixed-point: when you are sick, you can go to the designated hospital and designated pharmacy to see a doctor and buy medicine, so as to be able to get medical reimbursement;

2.Three catalogs: "Basic Medical Insurance Drug Catalogue", "Basic Medical Insurance Service Facilities Catalogue", "Basic Medical Insurance Diagnosis and Treatment Project Catalogue";

3.Minimum payment line: that is, the deductible, if the minimum payment line is 500 yuan, and only 300 yuan was spent on medical treatment, this part of the cost cannot be reimbursed;

4.Cap line: that is, the upper limit of the reimbursement amount, and you need to pay for expenses beyond this part;

5.Reimbursement ratio: For example, Class A drugs are 100% reimbursed in full, and Class B drugs are partially reimbursed, and they are paid separately.

Legal basis

Law of the People's Republic of China on Social Insurance and Reporting

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic friendship medical insurance** shall be settled directly by the social insurance agency and the medical institution and the drug business unit. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.

Article 31 According to the needs of management services, social insurance agencies may sign contracts with medical institutions and drug business units, and medical institutions shall provide reasonable and necessary medical services for insured persons.

Legal Analysis: Hospitalization Reimbursement Ratio.

1. The reimbursement ratio of 0-300 yuan for hospitalization in township health centers is 40%, and the reimbursement ratio for hospitalization of more than 300 yuan is 55%.

2. The reimbursement ratio of 0-300 yuan for hospitalization in county-level hospitals is 30%, and the reimbursement ratio for hospitalization above 300 yuan is 40%.

3. The reimbursement ratio of 0-20,000 yuan for hospitalization in hospitals outside the county is 20%, and the reimbursement ratio for more than 20,000 yuan is 35%.

4. Pregnant women who participate in maternal and child health care reimbursement shall be reimbursed according to the proportion of hospitalization in medical institutions. If the reimbursement amount is less than 200 yuan, the compensation will be 200 yuan.

Pregnant women who do not participate in maternal and child health insurance will not be reimbursed for hospital delivery.

5. Hypertension above the stage (inclusive), heart disease combined with cardiac insufficiency, diabetes mellitus with ineffective dietary control, and liver cirrhosis decompensation.

Period, outpatient chemoradiotherapy for malignant tumors, chronic bronchitis, maintenance of mental illness, hemodialysis for chronic renal failure, peritoneal dialysis.

11 specific chronic patients such as anti-rejection of organ transplantation**, aplastic anemia, leukemia, etc., are treated at village-level direct reimbursement points.

According to the reimbursement ratio of village-level outpatient clinics, those who seek medical treatment in medical institutions at or above the township level (referral is required for medical treatment outside the county) shall be different with the "Medical Treatment Certificate".

Reimbursement of hospitalization reimbursement rates for medical institutions.

6. The maximum amount of annual personal compensation is 60,000 yuan.

3) The scope of reimbursement for participating farmers is the drug fee, the first fee, the town fee for surgery, the fee for examination and testing, the prescribed nursing fee and the bed fee in the catalogue;

Legal basis: Law of the People's Republic of China on Social Protection and Fuel Insurance

Article 4 Employers and individuals within the territory of the People's Republic of China who pay social insurance premiums in accordance with law have the right to inquire about payment records and records of individual rights and interests, and to request social insurance agencies to provide social insurance consultation and other related services.

Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise their own units' contributions for them.

Article 5: The people at or above the county level shall include social insurance undertakings in their national economic and social development plans.

The state raises social insurance funds through multiple channels. The people at or above the county level shall give necessary financial support to the social insurance undertakings.

The state supports social insurance through preferential tax policies.

Legal analysis: reimbursement can be made after hospitalization and discharge, and there is no number of days rule. Information required for reimbursement of rural cooperative medical care:

1) Outpatient reimbursement materials: outpatient invoices, cooperative medical certificates (or medical records). (2) Hospitalization reimbursement information:

Hospitalization invoices, cooperative medical certificates (or medical records), bills of expenses, discharge summaries, and other relevant proofs. (3) Materials to be brought for reimbursement of outpatient special diseases: outpatient invoices, special medical cooperation medical certificates.

1) will prepare the required reimbursement materials and submit them to the village (community); (2) The cooperative medical liaison officer shall be reported by the village (community) cooperative medical liaison officer to the town cooperative medical liaison officer, and the township liaison officer shall reimburse the resettlement report center of the regional agronomic department.

Legal basis: "Social Insurance Law of the People's Republic of China" Article 24 The State shall establish and improve a new type of rural cooperative medical system. The management measures for the new type of rural cooperative medical care shall be stipulated by ***.