How to settle claims for Liminbao?
Li Minbao covers three aspects:
1. Personal expenses incurred during hospitalization that are included in the medical insurance catalog.
During the coverage period, the medical expenses incurred by the insured in medical insurance designated medical institutions that are within the scope of payment by the medical insurance fund, after being reimbursed by medical insurance, will exceed the deductible of 20,000 yuan (equivalent to the deductible for serious illness). Partial reimbursement is based on 55%, and the annual cumulative maximum payment limit is 1 million yuan.
2. Reasonable expenses incurred during hospitalization that are not reimbursed by medical insurance.
(1) Self-paid drugs:
"Taizhou Limin Insurance" has included 537 kinds of drugs that are not included in the medical insurance catalog into the scope of reimbursement, greatly expanding the scope of medical workers and patients in hospital. The range of drug choices during the period.
(2) Expenses for diagnostic and treatment services, medical materials that exceed the limited payment range, and medical materials that exceed the accumulated limit for a single item.
For these two expenses, the cumulative minimum payment threshold is 5,000 yuan, 30% is reimbursed for the part between 5,000 yuan and 30,000 yuan, 50% is reimbursed for the part above 30,000 yuan (inclusive), and the annual cumulative maximum payment limit is 1 million yuan.
3. Expenses for outsourcing innovative drugs for specific tumors and critical illness.
Considering that a large number of cancer and critically ill patients still need to take some high-value targeted therapies and other drugs for a long time during their non-hospitalization period, combined with the historical data of Taizhou disease spectrum, through various disease fields Experts selected and screened 32 innovative drugs and drugs for rare diseases.
The indications for these 32 drugs basically cover high-risk tumor diseases. Patients can purchase them with prescriptions at designated pharmacies in the city that have opened a one-stop card.
For this expense, the minimum payment line is 10,000 yuan, and the portion above the minimum payment line is reimbursed at a rate of 50%. The annual cumulative maximum payment limit is 1 million yuan.