1. Fund risk sharing: the pool size of the health insurance fund pool is limited, and if unlimited reimbursement is made, the health insurance fund pool may soon be depleted, affecting the sustainability of medical care;
2. Limited healthcare resources: healthcare resources are limited, including doctors, beds, and medical equipment, and so on. If MPS reimbursement is allowed to go uncapped, it may lead to over-utilization of medical resources, which in turn may affect the quality of care and treatment outcomes;
3. Cost control: The MPS fund needs to control its costs, so that it can be better utilized to safeguard the healthcare needs of more people. If there is no upper limit to the reimbursement of medical insurance, it may cause the expenditure of the medical insurance fund to go out of control, affecting the sustainable development of the whole medical insurance system.
Children's medical insurance reimbursement materials:
1, medical insurance card: need to provide children's medical insurance card to prove that it has been insured;
2, medical vouchers: need to provide children's medical records and medical cost invoices and other relevant documents to prove that the child did carry out the relevant medical services and pay the relevant costs;
3, proof of identity: the need to provide Children's valid identity documents and household registers and other documents to prove their identity and legitimacy;
4, treatment plan: you need to provide the treatment plan issued by the hospital and diagnostic certificates and other documents to prove that the child's diagnosis of the disease and treatment plan;
5, other materials: if necessary, you need to provide other related materials, such as hospitalization deposit vouchers, outpatient registration certificates, and so on.
In summary, the children's health insurance card outpatient reimbursement limit set a cap is necessary to help control the expenditure of the health insurance fund, to protect the sustainability of medical protection and the rational use of medical resources.
Legal basis
Article 28 of the Social Insurance Law of the People's Republic of China
Medical expenses that are in line with the basic medical insurance drug directory, diagnostic and treatment items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.
Article 29
The portion of the medical expenses of insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance administration organization and the medical institutions and drug business units.
The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.