proportion of medical insurance reimbursement for children residents:

1. proportion of outpatient reimbursement

within a year, the proportion of reimbursement for urban and rural residents in first-class hospitals (including community health service centers) is 3%.

2. The reimbursement rate for hospitalization

1. The reimbursement rate of the first-class hospital (community health service center) is 65%;

2. The reimbursement rate of secondary hospitals is 6%;

3. The reimbursement rate of tertiary hospitals is 55%.

iii. outpatient qifubiaozhun

within one year, the qifubiaozhun for outpatient and emergency medical expenses incurred by urban and rural residents in first-class hospitals (including community health service centers) is 8 yuan, and the maximum payment limit is 3, yuan.

IV. Qifubiaozhun for hospitalization

1. First-class hospitals (community health service centers) do not have Qifubiaozhun;

2. The deductible line of the secondary hospital is 3 yuan;

3. 5 yuan, the deductible line of tertiary hospitals.

reimbursement conditions for children's medical insurance

1. The medical expenses for outpatient serious illness that the insured person has gone through the examination and registration procedures for outpatient serious illness before seeing a doctor, and occurred when seeing a doctor in a designated hospital;

2. The designated medical institution where the insured sees a doctor has a * * fault or cannot keep an account due to the damage of the children's medical insurance certificate;

3. Being hospitalized in a non-designated medical institution in this city due to acute or critical illness;

4. transfer to a medical institution outside the city for hospitalization with the consent of the designated medical institution of children's medical insurance in this city or the municipal social insurance institution;

5. Being hospitalized in a medical institution outside the city due to an acute illness while visiting relatives or on vacation, and having gone through the registration formalities with the social insurance institution;

6. Medical expenses incurred by children with household registration in this city when they settle outside the city (limited to those who have gone through the registration procedures in different places with social insurance institutions in advance).

Children's insurance reimbursement application materials

1. Original fee receipt (valid within six months);

2. Detailed list of expenses;

3. Copy of inpatient medical records (stamped with the official seal of medical institution);

4. Certificate of disease diagnosis;

5. My children's medical insurance certificate;

6. Original and photocopy of the legal guardian's bank passbook (when the cash reimbursed is not transferred to the payment account);

Procedures for handling children's medical insurance

1. When the insured person needs to handle cash reimbursement, he/she should prepare all the materials to be provided and go to the Children's Medical Insurance Department of each branch of the municipal social insurance fund management in the insured place;

2. The staff of the Children's Medical Insurance Department of the Municipal Social Insurance Fund Administration or the Children's Medical Department will conduct a preliminary examination of the cash reimbursement data provided by the insured person, enter the relevant information into * *, and print the acceptance form and receipt if the information is complete and meets the conditions for cash reimbursement; If the information is incomplete, print a notice of completing the information, and make corrections when the information is complete; Do not meet the conditions of cash reimbursement, issue a notice of rejection;

3. The guardian or agent of the insured shall sign the above notice. If the cash reimbursed is not transferred to the payment account, the original or copy of the guardian's bank passbook (limited to the four major state-owned banks) shall be provided separately, and the staff shall enter the passbook account number, print the passbook account number sheet, and the insured shall sign for confirmation;

4. The staff will review the cash reimbursement materials, submit them to the leaders for approval and then pay them to the Planning Finance Department.

interpretation of medical insurance reimbursement policy for children residents

according to China's medical insurance policy, children residents need to know the relevant reimbursement ratio when enjoying medical insurance reimbursement. According to the latest policy, the proportion of medical insurance reimbursement for children residents varies according to different medical items and drug types. Generally speaking, children's medical insurance can cover a certain proportion of common basic medical expenses, such as outpatient expenses and hospitalization expenses, for example, the reimbursement rate can reach 8% or higher. However, for some high-end medical items or special drugs, the reimbursement rate may be relatively low. Therefore, children residents need to know the specific reimbursement ratio when using medical insurance, so as to make correct decisions when seeking medical care. At the same time, it should be noted that the medical insurance policy may change at any time, and it is suggested to pay attention to the interpretation and notice of relevant policies in time to ensure the rights and interests of medical insurance reimbursement.

Legal basis:

Regulations on Handling Medical Accidents:

Chapter V Compensation for Medical Accidents

Article 5 Compensation for medical accidents shall be calculated according to the following items and standards: (1) Medical expenses: medical expenses incurred in the treatment of personal injuries caused by medical accidents shall be calculated and paid on the basis of evidence, but the primary medical expenses shall not be included. If it is really necessary to continue treatment after closing the case, it will be paid according to the basic medical expenses. (2) Loss of time: if the patient has a fixed income, it shall be calculated according to the fixed income reduced by his absence from work, and if the income is more than three times the average annual salary of the employees in the place where the medical accident occurred, it shall be calculated according to three times; If there is no fixed income, it shall be calculated according to the average annual salary of employees on the ground where the medical accident occurred. (3) Hospitalization food allowance: calculated according to the standard of food allowance for ordinary staff of state organs in the place where the medical accident occurred. (4) Escort fee: If the patient needs special escort during hospitalization, it shall be calculated according to the average annual salary of employees in the last year where the medical accident occurred. (5) Disability living allowance: according to the level of disability and the average annual living expenses of residents in the place where the medical accident occurred, the maximum compensation is 3 years from the month of disability; However, those over 6 years of age shall not exceed 15 years; More than 7 years of age, not more than 5 years. (6) Disability appliance fee: if it is necessary to configure compensation functional appliances due to disability, it shall be calculated according to the cost of popular appliances with the certificate of medical institutions. (7) Funeral expenses: calculated according to the subsidy standard for funeral expenses stipulated in the place where the medical accident occurred. (8) Living expenses of the dependents: limited to those who were actually supported by the deceased or disabled before they lost their ability to work, and calculated according to the minimum living standard of the residents in their domicile or residence. For those under the age of 16, they will be raised to the age of 16. For those who have reached the age of 16 but have no ability to work, they will be supported for 2 years; However, those over 6 years of age shall not exceed 15 years; More than 7 years of age, not more than 5 years. (9) Transportation expenses: calculated according to the actual necessary transportation expenses of patients, and paid by credentials. (X) Accommodation fee: calculated according to the standard of travel accommodation allowance for general staff of state organs in the place where the medical accident occurred, and paid by credentials. (11) Spiritual damages: calculated according to the average annual living expenses of residents in the place where the medical accident occurred. If the patient dies, the compensation period shall not exceed 6 years at the longest; If the patient is disabled, the compensation period shall not exceed 3 years.