1. Reimbursement scope: general outpatient and emergency expenses incurred by the insured person in the medical insurance designated hospitals or specialized hospitals, traditional Chinese medicine hospitals and Class A hospitals of his/her choice.
2. Outpatient starting line: general outpatient and emergency expenses incurred in a natural year exceeding 1,800 yuan in total.
3. Reimbursement rate: 70% for hospitals and 90% for communities for the portion above 1800 yuan, and the ceiling line: 20,000 yuan.
4. Required materials:
Original ID card;
Original medical diagnostic certificate;
Original medical documents such as outpatient medical records, report cards of examination and test results;
Original receipts of fees for general outpatient services and emergency services,
Original list of outpatient expenses or original prescriptions (the prescriptions are pasted on the back of the receipts according to the date). ).
5. Submission time: 1-10th of each month, the current month's fees to be submitted the following month, the current year's fees need to be submitted by January of the following year.
6. Process: If the total amount exceeds the starting standard in a natural year, the unit operator will enter all the documents into the enterprise version of the software, and report the generated electronic information and statements to the medical insurance center, which will complete the audit, settlement and payment of reimbursement within 30 working days.
What is the health insurance?
1. General medical insurance
General medical insurance provides the insured with general medical expenses related to the treatment of illness. It mainly covers outpatient expenses, medicine and examination costs. This type of insurance has a lower premium cost and is more applicable to the general public. Because of the difficulty in controlling expenditures for medicine and examination costs, this type of policy generally has a deductible and cost-sharing provision, whereby the insurer pays a certain percentage of the portion above the deductible, and the cost of insurance is set once a year. The insurer is no longer responsible for expenses incurred for each illness that cumulatively exceed the insured amount.
2. Hospitalization Insurance
Hospitalization expenses are covered as a separate insurance policy because of the often high costs incurred for hospitalization. The main cost items covered by hospitalization insurance are daily hospital fees (bed charges), the cost of utilizing hospital equipment, surgical fees, and medical fees. The length of the hospitalization period will have a direct impact on its cost, so the amount of this insurance should be based on the patient's average hospitalization cost. In order to control unnecessarily long hospitalization, hospitalization insurance generally stipulates that the insurer is only responsible for a certain percentage of all costs, not all of them.
3. Surgical insurance
This type of insurance provides for all costs incurred by a patient who needs to undergo a necessary surgery.
4. Comprehensive medical insurance
Comprehensive medical insurance is a comprehensive medical expense coverage provided by the insurer to the insured, which covers all expenses incurred for medical treatment and hospitalization, surgery, and so on. This type of policy has a higher premium. A low deductible is generally established along with an appropriate sharing ratio.
5. Specialty Disease Insurance
Certain specialty diseases often bring catastrophic cost payments to the patient, which are difficult for the average residential family to bear. Examples include cancer, heart disease, etc. Therefore, people usually require such policies to have a relatively large sum insured to be sufficient to cover the various expenses incurred by them. The major diseases for which coverage is provided to policyholders can be single, such as malignant tumors, or even certain types of cancers among malignant tumors; or multiple, listing several agreed major diseases, such as malignant tumors, myocardial infarction, uremic poisoning, vital organ transplantation, tetraplegia, cerebral stroke and coronary artery bypass grafting surgery, and so on. Once after 180 days from the effective date of the insurance policy, the insured person is diagnosed by a certain level of hospitals with the major diseases agreed in the policy, you can apply to the insurance company to pay the full amount of insurance, the insurance liability will be terminated.