The reimbursement ratio of children's medical insurance is one of the topics that parents are more concerned about. The reimbursement ratio and minimum payment standards of children's medical insurance vary greatly in different regions.
What are the reimbursement ratios and minimum payment standards of children's medical insurance? We will introduce the reimbursement ratio and minimum payment standards of children's medical insurance in detail.
1. Outpatient reimbursement ratio Within a year, the reimbursement ratio for urban and rural residents in first-level hospitals (including community health service centers) is 30%.
2. Hospitalization reimbursement ratio 1. The reimbursement ratio for first-level hospitals (community health service centers) is 65%; 2. The reimbursement ratio for second-level hospitals is 60%; 3. The reimbursement ratio for third-level hospitals is 55%.
3. Outpatient payment minimum standard Within a year, for outpatient and emergency medical expenses incurred by urban and rural residents in first-level hospitals (including community health service centers), the minimum payment line is 800 yuan, and the maximum payment limit is 3,000 yuan.
4. Hospitalization deductible standards 1. There is no deductible for first-level hospitals (community health service centers); 2. The deductible for second-level hospitals is 300 yuan; 3. The deductible for third-level hospitals is 500 yuan.
Children's medical insurance reimbursement conditions 1. The insured person has completed the outpatient serious illness review and registration procedures before seeking treatment, and the outpatient serious illness medical expenses incurred when seeking treatment at the designated hospital; 2. The designated medical institution where the insured person visits has a computer failure or other reasons.
The children's medical insurance card cannot be recorded for reasons such as damage; 3. Hospitalization in non-designated medical institutions in this city due to acute or critical illness; 4. Transferred to the city with the consent of the city's children's medical insurance designated medical institutions or the city's social insurance institutions
Hospitalization in medical institutions outside the city; 5. Hospitalization in medical institutions outside the city due to acute illness during visits to relatives or vacations outside the city, and registration procedures with social insurance institutions; 6. Children and adolescents with household registration in this city settling outside the city
Medical expenses incurred (only if the off-site registration procedures have been completed with the social insurance institution in advance).
Children's insurance reimbursement application materials 1. Original fee receipt (valid within six months); 2. Detailed list of expenses; 3. Copy of hospitalization medical record (stamped with the official seal of the medical institution); 4. Disease diagnosis certificate; 5. My children's medical treatment
Insurance certificate; 6. The original and copy of the legal guardian's bank passbook (when the cash for reimbursement is not transferred to the payment account); Children's medical insurance application process 1. When the insured person needs to apply for cash reimbursement, all the required information must be prepared
, go to the Children's Medical Insurance Department of the municipal social insurance fund management branch in the insured place; 2. The staff of the Children's Medical Insurance Department or Children's Medical Department of the Municipal Social Insurance Fund Management Bureau will conduct a preliminary review of the cash reimbursement information provided by the insured person.
Enter the relevant information into the computer. If the information is complete and meets the conditions for cash reimbursement, the acceptance form and receipt will be printed; if the information is incomplete, a notice of completion of the information will be printed, and it will be corrected and accepted when the information is complete; if the information does not meet the conditions for cash reimbursement, a receipt will be issued.
Issue a notice of rejection; 3. The guardian or agent of the insured person signs the above notice. If the reimbursed cash is not transferred to the payment account, the original or copy of the guardian's bank passbook must be provided (limited to the four major banks).
State-owned bank), the staff enters the passbook account number, prints the passbook account form, and the insured person signs and confirms; 4. The staff reviews the cash reimbursement information, reports it to the leader for approval, and then submits it to the Planning and Finance Department for payment.