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No.1 of the 9 Model Cases Involving Examination of Regulatory Documents Incidental to Administrative Litigation Issued by the Supreme People's Court: Xu Yunying v. Social Medical Insurance Business Office of Wulian County in Shandong Province (denial of reimbursement of medical expenses)
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最高人民法院发布9起行政诉讼附带审查规范性文件典型案例之一：徐云英诉山东省五莲县社会医疗保险事业处不予报销医疗费用案
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No.1 of the 9 Model Cases Involving Examination of Regulatory Documents Incidental to Administrative Litigation Issued by the Supreme People's Court: Xu Yunying v. Social Medical Insurance Business Office of Wulian County in Shandong Province (denial of reimbursement of medical expenses)
(denial of reimbursement of medical expenses)
最高人民法院发布9起行政诉讼附带审查规范性文件典型案例之一：徐云英诉山东省五莲县社会医疗保险事业处不予报销医疗费用案
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| No.1 of the 9 Model Cases Involving Examination of Regulatory Documents Incidental to Administrative Litigation Issued by the Supreme People's Court: Xu Yunying v. Social Medical Insurance Business Office of Wulian County in Shandong Province (denial of reimbursement of medical expenses) | | 最高人民法院发布9起行政诉讼附带审查规范性文件典型案例之一：徐云英诉山东省五莲县社会医疗保险事业处不予报销医疗费用案 |
| 1. Basic facts | | （一）基本案情 |
Xu Yunying's husband, Liu Huanxi, suffered from advanced lung cancer complicating with brain metastasis. He was admitted to the Zibo Wanjie Cancer Hospital on April 8, 2014 and June 3, 2014 respectively. He died on July 8, 2014 despite medical efforts. His treatment at the Zibo Wanjie Cancer Hospital gave rise to medical expenses of CNY105,014.48. On July 21, 2014, Xu Yunying applied to the Social Medical Insurance Business Office of Wulian County for reimbursement of medical expenses under the New Rural Cooperative Medical Scheme (“RCMS”). On January 12, 2015, the Social Medical Insurance Business Office of Wulian County made the Written Reply of the Social Medical Insurance Business Office of Wulian County to the Application by Applicant Xu Yunying for RCMS Reimbursements (hereinafter referred to as the “Written Reply”), of the opinion that, according to the provisions of paragraph 2, Article 5 of the Implementation Measures for Administration of New Rural Cooperative Medical Scheme in Wulian County in 2014 (No. 2 [2014], Health) (hereinafter referred to as the “Implementation Measures”) issued by the Health Bureau of Wulian County and the Finance Bureau of Wulian County, the medical institution which Liu Huanxi sought medical care was not founded by the government, denying reimbursement. Xu Yunying applied to the People's Government of Wulian County for administrative reconsideration, in the belief that the policy by which the Social Medical Insurance Business Office of Wulian County denied reimbursement did not conform to the spirit of corresponding municipal and provincial policies and infringed on her lawful rights and interests. The People's Government of Wulian County was of the opinion that the Written Reply from the Social Medical Insurance Business Office of Wulian County conformed to the provisions, and made the Administrative Reconsideration Decision (No. 1 [2015], Administrative Reconsideration, Lian) on April 13, 2015, in favor of the Written Reply issued by the Social Medical Insurance Business Office of Wulian County. Xu Yunying filed suit, requesting that the people's court revoke the Written Reply made by the Social Medical Insurance Business Office of Wulian County and examine the legality of the regulatory document relied on by the Social Medical Insurance Business Office of Wulian County.
．．．．．． | | 徐云英的丈夫刘焕喜患肺癌晚期并发脑转移，先后于2014年4月8日、2014年6月3日两次入住淄博万杰肿瘤医院治疗，2014年7月8日医治无效去世。在淄博万杰肿瘤医院住院治疗期间，产生医疗费用105014.48元。2014年7月21日，徐云英申请五莲县社会医疗保险事业处给予办理新农合医疗费用报销。五莲县社会医疗保险事业处于2015年1月12日作出《五莲县社会医疗保险事业处关于对申请人徐云英合作医疗报销申请的书面答复》（以下简称《书面答复》），依据五莲县卫生局、五莲县财政局莲卫字〔2014〕2号《2014年五莲县新型农村合作医疗管理工作实施办法》（以下简称《实施办法》）第五条第二款的规定，认为刘焕喜就诊的医疗机构不属于政府举办的医疗机构，决定不予报销。徐云英认为五莲县社会医疗保险事业处不予报销所依据的政策规定不符合省、市相应政策规定的精神，侵犯其合法权益，为此向五莲县人民政府提出行政复议申请。五莲县人民政府认为五莲县社会医疗保险事业处的《书面答复》符合规定，于2015年4月13日作出莲政复决字〔2015〕1号行政复议决定维持五莲县社会医疗保险事业处作出的《书面答复》。徐云英起诉请求人民法院撤销五莲县社会医疗保险事业处作出的《书面答复》，同时，对五莲县社会医疗保险事业处所依据规范性文件的合法性进行审查。
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