Legal Analysis:

Accidental Injury Outpatient Clinic: The outpatient emergency medical expenses incurred by students and children due to accidental injuries, if the cumulative amount exceeds 100 yuan within the payment scope of the resident medical insurance fund, 90% is paid by the resident medical insurance fund, and the maximum payment limit in an insurance year is 1,000 yuan. The medical expenses are paid in advance by the patient, and then brought to the medical insurance office for reimbursement afterwards with outpatient medical records, invoices, copies of bank books (cards) and other documents. At the same time, the school issues a detailed explanation of the injury.

Hospitalization for accidental injury: If you are hospitalized after an accidental injury, the medical insurance office will send someone to investigate and verify the cause during the hospitalization to see if it is within the scope of medical insurance reimbursement. If there is no responsible person, the hospitalization medical expenses will be paid by the medical insurance fund according to the corresponding standards.

If an insured student is hospitalized due to accidental injury and there is no third-party responsible person, 50% of the hospitalization medical expenses within the overall planning scope will be paid by the basic medical insurance fund, with the maximum payment limit of 60,000 yuan.

Outpatient coordination benefits: The school can choose a designated community health service institution as the outpatient coordination designated medical institution for the insured students of the school. For the outpatient medical expenses incurred by insured students in designated medical institutions that meet the regulations, the fund will pay 50% at a proportion of 50%. Within an insurance year, the maximum payment limit is 120 yuan.

Legal basis:

"Social Insurance Law of the People's Republic of China"

Article 26: Basic medical insurance for employees, new rural cooperative medical insurance and The treatment standards of basic medical insurance for urban residents shall be implemented in accordance with national regulations.

Article 28 Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance fund shall be settled directly between the social insurance agency and the medical institution and pharmaceutical business unit. The social insurance administrative department and the health administrative department should establish a settlement system for medical expenses in other places to facilitate insured persons to enjoy basic medical insurance benefits.

Derived questions:

What kind of compensation should a child receive for an accidental injury at school? 1. Children under the age of 8 are persons without capacity for civil conduct. Children attend school and are under the supervision and protection of the school. The school has the responsibility to protect the child’s personal safety. In this case, due to the implementation of the proof-of-concept requirement for the school The principle of inversion of responsibility,

The school should prove its responsibility for the child's accidental injury. If the school cannot prove that it is not its own fault, the school should bear the liability for compensation. If the school is partially at fault, it will bear the responsibility proportionally.

2. If a minor over 8 years old is a person with limited capacity for civil conduct and is injured at school, the injured party shall prove that the school is at fault. Within the scope of the fault, the school shall bear corresponding liability for compensation according to the proportion of fault. .