How do you get reimbursed under rural cooperative medical care? A detailed explanation of the reimbursement process

Rural cooperative medical care is a mutual-aid medical security system created by Chinese farmers themselves. It has played an important role in ensuring that farmers obtain basic health services and in alleviating poverty caused by illness and relapse into poverty caused by illness. The reimbursement scope roughly includes three parts: outpatient compensation, inpatient compensation and major illness compensation. Let us take a look below at how rural cooperative medical care reimbursement works!

Reimbursement scope of the new rural cooperative medical care

The reimbursement scope of the new rural cooperative medical care covers the portion of drug costs, examination fees, laboratory fees, surgery fees, treatment fees, nursing fees and other expenses incurred by insured persons during the pooling period for illness diagnosis and treatment as inpatients at designated hospitals that conform to the reimbursement scope of urban employee medical insurance (that is, effective medical expenses). The fund payment sets a deductible threshold and a maximum payment limit. Inpatient expenses below the hospital's annual deductible threshold are paid by the individual. Within the same pooling period, once the deductible threshold has been reached, inpatient expenses incurred from two or more hospitalizations may be reimbursed cumulatively. Inpatient expenses exceeding the deductible threshold are calculated in tiers and reimbursed cumulatively, and there is an annual cumulative reimbursement cap per person.

Reimbursement process of the new rural cooperative medical care

1. Insured patients under the new rural cooperative medical care must present their own medical card and valid ID (or household register if they have no ID). After identity confirmation, they can directly swipe their card for reimbursement at designated general outpatient medical institutions at the township level within the district, and for inpatient care at designated medical institutions within the district and within the city outside the district, they can directly swipe their card for reimbursement when settling the bill upon discharge.

2. For insured patients receiving inpatient treatment at public medical institutions at the second level or above outside the city, within three months after discharge, the insured person or their family member should bring the original medical expense invoice (photocopies are invalid), the summarized detailed list of inpatient medical expenses, the discharge summary and outpatient medical records, the patient's ID, medical card, household register, and the handler's ID to windows 14 and 15 of the new rural cooperative medical care at the first floor of the district administrative service center to reimburse medical expenses.

3. For outpatient reimbursement for special disease types, patients may present medical records issued by designated medical institutions at the second level or above and relevant materials such as related examination and laboratory reports, as well as a certificate from the medical institution, and the "Huangyan District New Rural Cooperative Medical Care Special Disease Outpatient Treatment Approval Form" to apply to the new rural cooperative medical care management center. After review and approval by the district new rural cooperative medical care office, the outpatient medical expenses (excluding medical expenses for supportive therapy, adjuvant treatment or treatment of other diseases) may be included in the reimbursement scope of the new rural cooperative medical care fund and reimbursed on an annual basis according to the inpatient reimbursement standard.

4. For inpatient patients hospitalized due to accidental injury, after discharge they must also submit a confirmation certificate signed and sealed by the village (neighborhood) where their household register is located confirming the cause of the accidental injury, as well as the hospital's medical record. Those who cannot provide valid proof and records will not be accepted.

Notes on rural cooperative medical care reimbursement

1. Outpatient medical expenses at non-designated hospitals within the district (except outpatient treatment expenses for special disease types), expenses incurred from seeking medical care without following regulations, and expenses from self-purchased drugs are not included in the reimbursement scope of the new rural cooperative medical care.

2. Expenses required for family planning measures and medical expenses that violate family planning policy are not included in the reimbursement scope of the new rural cooperative medical care.

3. Expenses such as dental crowns, orthodontics, optometry and glasses fitting, hearing aids, artificial organs, cosmetic treatment, plastic surgery and orthopedic surgery, rehabilitative medical care, as well as various companion fees, transportation fees for medical visits, home visit fees and other miscellaneous fees during hospitalization are not included in the reimbursement scope of the new rural cooperative medical care.

4. Where third-party liability exists, medical expenses arising from personal injury are borne by the third-party liable party according to law; cases such as traffic accidents, medical accidents and work-related injuries are not included in the reimbursement scope of the new rural cooperative medical care.

5. Medical expenses arising from injuries caused by illegal acts such as suicide, self-harm, poisoning, drug use and fighting, as well as intentional acts by their family members, are not included in the reimbursement scope of the new rural cooperative medical care.

6. Medical expenses incurred while abroad or during periods in Hong Kong, China, Macao, China and Taiwan, China are not included in the reimbursement scope of the new rural cooperative medical care.

7. Drugs and items that are not reimbursable under the provisions of the urban employee medical insurance system are not included in the reimbursement scope of the new rural cooperative medical care.

8. Other expenses determined by the district medical management committee as not reimbursable.