I. Participation and treatment of children's medical insurance
Shanghai's children's medical insurance policy aims to provide basic medical insurance for children, and the scope of protection usually includes children registered in this city and children who meet certain conditions. After enrollment, children can enjoy part of the medical expenses paid by the medical insurance fund when they seek medical treatment, which greatly reduces the economic burden of families.
Second, the meaning of 300 yuan Qifubiaozhun
300 yuan Qifubiaozhun for children's medical insurance means that within the scope stipulated by the medical insurance policy, the insured children should bear the medical expenses in 300 yuan first. This lump sum amount is not included in the scope of medical insurance fund payment. Only when the medical expenses exceed this amount can the excess be paid by the medical insurance fund in accordance with the provisions of the medical insurance policy.
Third, the role of Qifubiaozhun
Qifubiaozhun setting has the following functions:
Reduce the payment pressure of the medical insurance fund: By setting the minimum payment standard, the medical insurance fund can reduce the payment of small medical expenses, thus better ensuring the payment of large medical expenses and improving the efficiency of the medical insurance fund.
Encourage the rational use of medical resources: the existence of Qifubiaozhun can make the insured and their families use medical resources more reasonably and economically, and avoid unnecessary waste and excessive consumption.
Enhance personal responsibility awareness: by letting the insured bear part of the medical expenses, enhance personal responsibility awareness and risk awareness, and promote health management and preventive health care.
Fourth, matters needing attention
It should be noted that the minimum payment standard is not static and may change with the adjustment of medical insurance policy. Therefore, the insured and their families should know the latest medical insurance policy in time before seeking medical treatment, so as to better enjoy medical insurance benefits.
To sum up:
Shanghai children's medical insurance 300 minimum deductible means that in Shanghai, when children's medical insurance participants enjoy medical insurance benefits, they need to bear the medical expenses of 300 yuan first, and the part exceeding this amount can only be paid by the medical insurance fund. The setting of the co-payment standard aims to reduce the payment pressure of the medical insurance fund, encourage the insured and their families to use medical resources rationally and enhance their sense of personal responsibility. Insured personnel should keep abreast of the latest medical insurance policies in order to better enjoy medical insurance benefits.
Legal basis:
Measures of Shanghai Municipality on Basic Medical Insurance for Employees
Article 12 stipulates:
The minimum deductible is set for the medical expenses of outpatient emergency (including family beds) and hospitalization (including emergency observation room for hospitalization observation) paid by the basic medical insurance fund for employees in this Municipality. Medical expenses below Qifubiaozhun shall be borne by individuals.
People's Republic of China (PRC) social insurance law
Article 28 provides that:
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.