1. Fund risk sharing: the scale of medical insurance fund pool is limited. If unlimited reimbursement, the medical insurance fund pool may soon be exhausted, affecting the sustainability of medical insurance;

2. Limited medical resources: Limited medical resources, including doctors, beds and medical equipment. If there is no upper limit for medical insurance reimbursement, it may lead to over-utilization of medical resources, which will further affect medical quality and treatment effect;

3. Cost control: The medical insurance fund needs to control costs in order to better protect the medical needs of more people. If there is no upper limit for medical insurance reimbursement, it may make medical insurance fund expenditure out of control and affect the sustainable development of the whole medical insurance system.

Children's medical insurance reimbursement materials:

1, medical insurance card: Children's medical insurance card is required to prove that they are insured;

2. Medical treatment certificate: it is necessary to provide the child's medical records and medical expense invoices and other relevant documents to prove that the child has indeed provided relevant medical services and paid relevant expenses;

3. Proof of identity: the child's valid identity document, household registration book and other documents are required to prove his identity and legitimacy;

4. Treatment plan: it is necessary to provide documents such as treatment plan and diagnosis certificate issued by the hospital to prove the child's disease diagnosis and treatment plan;

5. Other materials: If necessary, other relevant materials such as hospitalization deposit certificate and outpatient registration certificate shall be provided.

To sum up, it is necessary to set an upper limit on the reimbursement amount of children's medical insurance card outpatient service, which is helpful to control the expenditure of medical insurance fund and ensure the sustainability of medical insurance and the rational use of medical resources.

legal ground

Article 28 of People's Republic of China (PRC) Social Insurance Law

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.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.