1, a file of children's medical insurance and a file of children's medical insurance refers to the medical security policy provided by the Shenzhen municipal government for children aged 0-6 in the city. Children who enjoy medical insurance do not need to pay medical insurance fees. The medical coverage of the first-class children's medical insurance includes outpatient and inpatient medical expenses, hepatitis B vaccine and vaccination.
2. Second grade children's medical insurance. Second-grade children's medical insurance refers to the medical insurance managed by Shenzhen Social Insurance Fund Management Center. Children and their families need to pay medical insurance fees, and the reimbursement rate is 90%. The second-level children's medical insurance includes not only the medical scope in the first-level children's medical insurance, but also special outpatient service, special medical treatment, special disease outpatient service, rehabilitation treatment, medical examination and medical imaging.
The process of medical insurance reimbursement:
1, medical treatment: go to a hospital or clinic for medical treatment or treatment;
2. Payment: Pay the medical expenses that should be paid in the hospital or clinic;
3. Obtain a list of expenses: during the medical treatment, the hospital or clinic will provide a list of expenses, which lists the specific medical items and amount;
4. Fill in the reimbursement application form: hold the expense list and fill in the medical insurance reimbursement application form. You need to provide your own basic information, medical expenses list, medical insurance certificate and other related materials when filling in;
5. Submit materials: submit the completed reimbursement application form and related materials to the medical insurance agency, which can be submitted online or offline;
6. Audit: The medical insurance agency shall audit the submitted application forms and materials. After the approval, the medical insurance agency will transfer the reimbursement funds into the personal bank account or give cash reimbursement.
To sum up, in the process of reimbursement of medical expenses, the insured should abide by the relevant regulations, such as not making false reports or reimbursing in disguise, so as to avoid unnecessary losses in violation of the relevant regulations.
Legal basis:
Article 28 of People's Republic of China (PRC) Social Insurance Law
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
Article 29
The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.