1. First, students and children. In a settlement year, medical expenses below RMB 6,543,800,000+800,000 were incurred, which were within the scope of reimbursement. The threshold of tertiary hospitals is 500 yuan, and the reimbursement rate is 55%.
2. The Qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%.
3. There is no Qifubiaozhun in the first-level hospital, and the reimbursement rate is 65%.
After children's medical insurance, they can enjoy four kinds of treatment: hospitalization, emergency, outpatient special diseases and accidental injury additional insurance:
1. Hospitalization medical insurance benefits. Within one year, the first-class hospital (community health service center) will not set the deductible line for hospitalization medical expenses below 6.5438+0.8 million yuan, and will be reimbursed 65%; 300 yuan, the deductible line of the secondary hospital, reimbursed 60%; 500 yuan, the deductible line of tertiary hospital, will be reimbursed by 55%.
2. Outpatient special disease reimbursement treatment. The deductible line for outpatient special diseases within one year is 300 yuan, and the highest payment limit and reimbursement ratio are implemented according to the hospitalization reimbursement standard. Special outpatient diseases include: renal dialysis, anti-rejection after renal transplantation, tumor radiotherapy and chemotherapy analgesia, diabetes, cor pulmonale, lupus erythematosus, hemiplegia, psychosis, hemophilia, anti-rejection after liver transplantation, epilepsy, aplastic anemia and chronic thrombocytopenic purpura.
3. Emergency reimbursement treatment. Within one year, the deductible line of emergency medical expenses incurred by urban and rural residents in first-class hospitals (including community health service centers) is 800 yuan, with the maximum payment limit of 3000 yuan and 30% subsidy.
4. Additional insurance benefits for students' accidental injuries. On the basis of the basic medical insurance for urban and rural residents, a unified supplementary insurance for accidental injuries of students and children will be established to solve the problems of medical expenses compensation, disability and death subsidies for students and children due to accidental injuries.
Reimbursement conditions:
1. The insured person has already gone through the registration procedures for outpatient serious illness before seeing a doctor, which is the medical expenses for outpatient serious illness that occurred when seeing a doctor in a designated hospital.
2, the designated medical institutions computer failure or due to children's medical insurance card damage and other reasons can not be accounted for.
3. Being hospitalized in a non-designated medical institution in this Municipality due to critical illness.
4, the city's children's medical insurance designated medical institutions or municipal social insurance institutions agreed to transfer to medical institutions outside the city for hospitalization.
5. During the period of visiting relatives outside the city or during the vacation, he was hospitalized in a medical institution outside the city due to acute diseases and has gone through the registration formalities with the social insurance institution.
6. The medical expenses incurred by children with household registration in this city when they settle outside the city do not include those who have gone through the registration formalities in different places at social insurance institutions in advance.