The legal provisions on reimbursement conditions of children's medical insurance are closely related to our daily work or life. So, you can't just hear about it, but you don't know how. The following small series has compiled some related contents to share with you. Welcome to read, I hope it will help you. I. Reimbursement conditions 1. The insured person has gone through the registration formalities for outpatient serious illness examination before seeing a doctor. But also the outpatient medical expenses when a serious illness is treated in a designated hospital. 2. The designated medical institution where the insured sees a doctor has a computer failure or is unable to keep an account due to the damage of the children's medical insurance certificate. 3. Being hospitalized in a non-designated medical institution in this Municipality due to critical illness. 4. With the consent of the designated medical institutions for children's medical insurance in this Municipality or the municipal social insurance institutions, they will be transferred to medical institutions outside the city for hospitalization. 6. The medical expenses incurred by the registered children in this city when they settle outside the city do not include the reimbursement ratio of secondary and tertiary hospitals 1, secondary hospitals 300 yuan, secondary hospitals 200 yuan, hospitals 100 yuan; 2. The proportion of hospitalization reimbursement has increased on the previous basis. For example, the reimbursement rate of tertiary hospitals has increased from 60% to 70%, secondary hospitals from 65% to 80%, and primary hospitals from 70% to 85%. 3. The proportion of reimbursement for hospitalization in different places has increased from 60% to 70%; 4. In the community health service institutions or medical institutions where the school is located, the medical fund will be paid at the rate of 80%, and the medical funds in other medical institutions will be paid at the rate of 50%. Well, the above data are the relevant answers to the legal provisions on reimbursement conditions of children's medical insurance collected by Bian Xiao. I believe that everyone who carefully reads this article will have a clearer and deeper understanding of the legal provisions on the reimbursement conditions of children's medical insurance. If you need more legal answers, you can consult a lawyer online!
Legal objectivity:
Medical insurance is insurance to compensate medical expenses caused by diseases. Social insurance in which employees are provided with necessary medical services or material assistance by society or enterprises due to illness, injury or childbirth. For example, free medical care and labor insurance medical care in China. The medical expenses of employees in China are shared by the state, units and individuals to reduce the burden on enterprises and avoid waste. The scope of medical insurance is very wide. Generally, medical expenses are distinguished according to the characteristics of medical services, including doctor's outpatient expenses, medicine expenses, hospitalization expenses, nursing expenses, hospitalization miscellaneous expenses, operation expenses, and various inspection expenses. Medical expenses are all kinds of expenses incurred by patients to treat diseases, including not only doctors' medical expenses and operation expenses, but also hospitalization expenses, nursing expenses and hospital equipment expenses. Proportion and scope of medical insurance reimbursement: 1, outpatient and emergency medical expenses: medical expenses within the accumulative scope of employees' basic medical insurance year (11February1February 3 1) exceed 2,000 yuan. 2. Settlement ratio: 50% of the part of the dispatched personnel above 2,000 yuan will be reimbursed during the contract period, and 50% will be paid by the individual; Within one year, the maximum amount of accumulated reimbursement for outpatient and emergency services of dispatched personnel is 20,000 yuan. 3. The insured shall properly keep the medical documents (including receipts and prescriptions for large amounts) in the outpatient department of the designated hospital. ), as a medical expense reimbursement certificate. 4. Outpatient treatment of three kinds of special diseases: when the insured person needs to take anti-rejection drugs after radiotherapy and chemotherapy for malignant tumor, renal dialysis and renal transplantation, the second-and third-level designated hospitals where the insured person is treated will issue the Certificate of Disease Diagnosis, fill in the Application and Approval Form for Special Diseases of Medical Insurance, and report it to the district medical insurance center for approval and filing. Outpatient treatment and drug collection for these three special diseases are limited to designated hospitals that have approved treatment, and cannot be purchased in designated retail pharmacies. The medical expenses incurred meet the prescribed scope of outpatient special diseases, with reference to hospitalization settlement. 5, hospitalization, medical insurance paid for 20 years, can enjoy medical insurance reimbursement after retirement. The reimbursement ratio and scope of rural cooperative medical insurance: 1, outpatient reimbursement: (1) 60% for village clinics and village center clinics, and the limit of prescription drug cost per visit is 10 yuan, and the limit of prescription drug cost for temporary rehydration of doctors in health centers is 50 yuan. (2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan. (3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan. (4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan. (5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan. (6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan. 2. Reimbursement scope of hospitalization compensation (1): a. Drug expenses: auxiliary examination: examination expenses such as electrocardiogram, X-ray fluoroscopy, filming, laboratory tests, physical therapy, acupuncture, CT, nuclear magnetic resonance, etc. 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan. (2) Reimbursement ratio: town hospitals reimburse 60%; 40% reimbursement for secondary hospitals. 3. Serious illness compensation town risk fund compensation: All inpatients who participate in cooperative medical care whose medical expenses exceed 5,000 yuan at one time or for the whole year shall be compensated by stages, that is, 500 1- 10000 yuan is 65%,1001-.