However, at present, many cities in Jiangsu have their own exclusive Huimin insurance, such as:
Nanjing: Ninghuibao Phase II
Suzhou: Su 2022, Su Kangbao 2022
Zhenjiang: Zhenjiang Huimin newspaper
Wuxi: Yi Hui Xicheng 2022
Xuzhou: Xu Hui Bao
Taizhou: Taizhou citizen insurance
Then the question comes: Which is better, the provincial medical Bao Hui 1 or the municipal Huimin insurance?
First, the horizontal comparison of Jiangsu Huimin insurance is not much to say. Directly above, the provincial version of Jiangsu Medical Bao Hui 1 is compared with the exclusive Huimin insurance of each city.
1. Jiangsu yihuibao 1 and Nanjing Huimin Bao
2. Jiangsu Yihuibao 1 and Suzhou Huimin Bao
3. Jiangsu Yihuibao 1 and Zhenjiang Huimin Bao
4. Jiangsu Yihuibao 1 and Wuxi Huimin Bao
5. Jiangsu Yihuibao 1 and Xuzhou Huimin Insurance.
6. Jiangsu Yihuibao 1 and Taizhou Huimin Bao
The difference is in the picture, just look at the picture carefully ~
Second, which reimbursement is more? Admittedly, each has its advantages and disadvantages. Let's take an example to see which reimbursement amount is more under the same circumstances.
Discuss in two situations:
1. Nonspecific past diseases
Mr. Y was hospitalized for lung cancer many times in the same policy year, and the total medical expenses were 852,600 yuan, including 467,200 yuan for reimbursement from the medical insurance pooling fund and serious illness insurance, and 385,400 yuan for personal expenses. Details are as follows:
Out-of-pocket expenses of inpatients in the medical insurance catalogue: 1 1.2 1 ten thousand yuan.
Out-of-pocket expenses of inpatients outside the medical insurance catalogue: 73,300 yuan.
The cost of purchasing out-of-hospital targeted drugs in designated pharmacies: 200,000 yuan.
(1) yihuibaodi 1
Reimbursable amount of hospitalization expenses in medical insurance catalogue =100000× 65%+(10000-deductible163843812406750700 )× 77%.
Reimbursable amount of hospitalization expenses out of medical insurance catalogue = (out of 73,300, 62,000 can be reimbursed according to medical insurance No.65438 +0- deductible 20,000) × 55% = 2.3 1 0,000.
Reimbursable amount of critical illness reinsurance = (1 1.2 1 10,000+62,000-66,600 -2.3 1 10,000-deductible 50,000) ×45% = 1.55 million.
To sum up, the total claim amount of Jiangsu Huimin Medical Insurance Bao HuiNo.1= 66,600 +2.3 1, 000+1.55 million = 1.05 million.
(2) Nanjing Ninghuibao Phase II
Reimbursable amount of hospitalization expenses in medical insurance catalogue = (1 1.2 1 10,000-deductible line 1.8 million) × 90%16384381240675078,000.
Reimbursable amount of hospitalization expenses out of medical insurance catalogue = (73,300 yuan-20,000 yuan out of pocket) × 50% = 26,700 yuan.
To sum up, the total claim amount of Nanjing Ninghuibao Phase II is = 82900+26700 = 109600.
(3) Su Kangbao 2022
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-deductible of 8,000) × 80% = 83,300.
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-20,000 out-of-pocket expenses) × 50% = 26,700.
Reimbursable amount for purchasing out-of-hospital targeted drugs in designated pharmacies = (200,000-deductible 0) × 80% =160,000.
To sum up, Su Kangbao's total claim amount in 2022 = 83,300+26,700+65,438+0.6 million = 270,000.
④ Su 2022
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-deductible 30,000) × 90% = 73,900.
Reimbursement amount of self-funded expenses of inpatients outside the medical insurance catalogue =0
Reimbursable amount for purchasing out-of-hospital targeted drugs in designated pharmacies = (200,000-deductible 0) × 70% =140,000.
To sum up, the total amount claimed by the Soviet Union in 2022 is = 73,900+0+1.400 = 21.390.
(5) Zhenjiang Huimin Insurance 299 Yuan Edition
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-deductible1.50,000) × 80% = 77,700.
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-self-pay line 1.5 million) × 80% = 46,600.
Reimbursable amount of expenses for purchasing out-of-hospital targeted drugs in designated pharmacies = (200,000-deductible 65,438+0,000) × 70% = 65,438+0.33 million.
Secondary reimbursement amount for severe malignant tumor = 20,000.
To sum up, the total claim amount of Zhenjiang Huimin Insurance = 77,700+46,600+65,438+033,000+20,000 = 277,300.
(6) Yi Hui Xicheng 2022
Out-of-pocket reimbursement amount of inpatients in medical insurance catalogue =0
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-20,000 out-of-pocket expenses) × 60% = 32,000.
Reimbursable amount of expenses for purchasing out-of-hospital targeted drugs in designated pharmacies = (200,000-deductible 20,000) × 70% =126,000.
To sum up, the total claim amount of Yi Hui Xicheng 2022 is 0+32,000+654.38+026,000 = 654.38+058,000.
(7) Xu Hui Bao
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-self-pay line1.9,000) × 60% = 55,900.
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-20,000 out-of-pocket expenses) × 50% = 26,700.
Reimbursable amount of expenses for purchasing out-of-hospital targeted drugs in designated pharmacies =0.
To sum up, the total amount claimed by Huizong = 55900+26700+0 = 82600.
(8) Taizhou Citizen Insurance 365 Yuan Edition
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-deductible 20,000) × 75% = 6.9 1 10,000.
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-20,000 out-of-pocket expenses) × 50% = 26,700.
Reimbursable amount of expenses for purchasing out-of-hospital targeted drugs in designated pharmacies =0.
To sum up, the total claim amount of Taizhou citizen insurance = 69 1, 000+26700+0 = 95800.
Therefore, assuming the same expenses, regardless of other factors, the reimbursable amount is ranked as follows:
Zhenjiang Huimin Insurance > Su Kangbao 2022 & gt Su 2022 & gt Yi Hui Xicheng 2022 & gt Nanjing Ninghuibao Phase II > Yihuibao 1No. > Taizhou Citizen Insurance > Xu Huibao
It must be noted that the final reimbursement amount of each product will definitely be different for different diseases. The above is only a hypothesis, which has certain reference significance, but it is by no means the basis for choice.
2. Specific past diseases
What about the same situation and cost, if you have a specific past illness before insurance?
Mr y was diagnosed with lung cancer three months before the insurance. After the policy came into effect, he was hospitalized for lung cancer many times in the same policy year. The medical expenses totaled 852,600 yuan, of which 467,200 yuan was reimbursed by the medical insurance pooling fund and serious illness insurance, and 385,400 yuan was borne by individuals. Details are as follows:
Out-of-pocket expenses of inpatients in the medical insurance catalogue: 1 1.2 1 ten thousand yuan.
Out-of-pocket expenses of inpatients outside the medical insurance catalogue: 73,300 yuan.
The cost of purchasing out-of-hospital targeted drugs in designated pharmacies: 200,000 yuan.
(1) yihuibaodi 1
Reimbursable amount of hospitalization expenses in medical insurance catalogue =100000× 55%+(10000-deductible163843812406750700 )× 67%.
Reimbursable amount of hospitalization expenses out of medical insurance catalogue = (out of 73,300, 62,000 can be reimbursed according to the number of medical insurance 1- deductible 20,000) ×45%= 1.89 million.
Reimbursable amount of critical illness reinsurance = (11.21000+62000-564001638438124075078900-deductible 50000) × 30.
To sum up, Jiangsu Huimin Medical Insurance Bao HuiNo. 1 total claim amount = 56,400+1.89 million+1.7 1 10,000 = 92,400.
(2) Nanjing Ninghuibao Phase II
Reimbursable amount of hospitalization expenses in medical insurance catalogue = (1 1.2 1 10,000-deductible line 1.8 million) × 60%16384381240675078,000.
Reimbursable amount of hospitalization expenses out of medical insurance catalogue = (73,300-20,000 out of pocket) ×30% = 1.6 million.
To sum up, the total claim amount of Nanjing Ninghuibao Phase II is = 54,700+65,438+0.6 million = 70,700.
(3) Su Kangbao 2022
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-deductible of 0.8 million) × 60% = 62,500.
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-20,000 out-of-pocket expenses) × 50% = 26,700.
Reimbursable amount of expenses for purchasing out-of-hospital targeted drugs in designated pharmacies = (200,000-deductible 0)×0%=0.
To sum up, Su Kangbao's total claim amount in 2022 is = 62,500+26,700+0 = 89,200.
④ Su 2022
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-deductible 30,000) × 30% = 24,600.
Reimbursement amount of self-funded expenses of inpatients outside the medical insurance catalogue =0
Reimbursable amount for purchasing out-of-hospital targeted drugs in designated pharmacies = (200,000-deductible 0) × 30% = 60,000.
To sum up, the total claim amount of Su in 2022 = 24,600+0,600 = 84,600.
(5) Zhenjiang Huimin Insurance 299 Yuan Edition
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-deductible1.50,000) × 80% = 77,700.
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-self-pay line 1.5 million) × 60% = 35,000.
Reimbursable amount of expenses for purchasing out-of-hospital targeted drugs in designated pharmacies = (200,000-self-payment line 1 0,000) × 30% = 57,000.
Secondary reimbursement amount for severe malignant tumor = 20,000.
To sum up, the total claim amount of Zhenjiang Huimin Insurance = 77,700+35,000+57,000+20,000 =189,700.
(6) Yi Hui Xicheng 2022
Out-of-pocket reimbursement amount of inpatients in medical insurance catalogue =0
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-20,000) ×20% = 1.07 million.
Reimbursable amount for purchasing out-of-hospital targeted drugs in designated pharmacies = (200,000-deductible 20,000) × 20% = 36,000.
To sum up, the total claim amount of Yi Hui Xicheng 2022 = 0+ 1700+36000 = 46700.
(7) Xu Hui Bao
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-self-pay line1.9,000) × 60% = 55,900.
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-20,000 out-of-pocket expenses) × 50% = 26,700.
Reimbursable amount of expenses for purchasing out-of-hospital targeted drugs in designated pharmacies =0.
To sum up, the total amount claimed by Huizong = 55900+26700+0 = 82600.
(8) Taizhou Citizen Insurance 365 Yuan Edition
Reimbursable amount of out-of-pocket expenses of inpatients in the medical insurance catalogue = (1 1.2 1 10,000-deductible 20,000) × 75% = 6.9 1 10,000.
Reimbursable amount of out-of-pocket expenses of inpatients outside the medical insurance catalogue = (73,300-20,000 out-of-pocket expenses) × 50% = 26,700.
Reimbursable amount of expenses for purchasing out-of-hospital targeted drugs in designated pharmacies =0.
To sum up, the total claim amount of Taizhou citizen insurance = 69 1, 000+26700+0 = 95800.
Therefore, assuming the same expenses, if the previous diseases cost the same amount, regardless of other factors, the ranking of reimbursement amount will change obviously:
Zhenjiang Huimin Insurance > Taizhou Citizen Insurance > Yihuibao 1No. > Su Kangbao 2022 & gt Su 2022 & gt Xu Huibao > Ning Huibao Phase II > Yi Hui Xicheng 2022
Of course, because different products have different definitions of past diseases, the final reimbursement amount of different past diseases will definitely be different.
At this point, there is no standard answer to the question "Should Jiangsu Huimin Bao buy the medical Bao Hui 1 or the city-specific version?".
But there are a few suggestions for reference:
Health status can be known through regular millions of medical insurance, and there is no exemption from previous diseases. It is recommended to choose millions of medical insurance first.
If there is exclusive insurance for the benefit of the people in the local area, for example, the insured of Nanjing Medical Insurance can buy Medical Bao Hui 1 and Nanjing Ninghuibao Phase II. It is suggested to buy both, learn from each other's strengths and deduct the deductible from each other.
If there is no exclusive Huimin insurance in the local area, you can directly purchase Jiangsu Medical Bao Hui 1.