Generally speaking, the insurance liability of Pacific Blue Medical Insurance includes hospitalization expenses, outpatient expenses, outpatient emergency expenses before and after hospitalization, specific drug protection and reimbursement of operation expenses. However, this product also has some limitations, such as:
1. Reimbursement amount and deductible: According to the age, health status, occupation and other factors of the insured, insurance companies set different reimbursement amounts and deductibles, which need to be selected when applying for insurance.
2. Health notification: Before buying insurance, you need to fill in the health notification form truthfully and inform yourself of your health status and medical history, so that the insurance company can judge whether to underwrite it.
3. Conditions for renewal: The conditions for renewal are usually stipulated in the insurance contract. If the health status of the insured changes or other risk factors during the renewal period, it may affect the renewal or insurance payment.
Conditions for reimbursement of medical insurance in different places:
1, participation status: reimbursement for medical insurance in different places is only applicable to those who participate in medical insurance systems such as urban workers' basic medical insurance, urban and rural residents' basic medical insurance and new rural cooperative medical care;
2. Payment record: when applying for reimbursement in different places, the applicant must have paid the medical insurance fee and meet the requirements of payment time and standard;
3. Reimbursement scope: policies such as reimbursement scope and reimbursement ratio of medical insurance in different places shall be subject to the relevant policies and regulations of the insured place. It should be noted that medical insurance reimbursement policies may be different in different regions, and applicants need to handle them according to local policies and regulations;
4. Hospital selection: When seeking medical treatment in different places, the applicant must choose a designated medical institution for medical insurance, otherwise he will not be able to enjoy medical insurance reimbursement;
5. Reimbursement application materials: Applicants need to prepare complete reimbursement application materials, including medical bills, expense lists, medical treatment certificates in different places, and reimbursement application forms.
To sum up, the reimbursement ratio and scope of medical insurance reimbursement may be different in different places. Generally speaking, the reimbursement rate of medical insurance reimbursement in different places may be lower than that of local medical insurance reimbursement. Please consult the local medical insurance department for details.
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.