1, in a medical insurance year, the total outpatient medical expenses (including emergency) paid by the community outpatient co-ordination fund to each insured person of inpatient medical insurance shall not exceed the maximum in 800 yuan.
2. 70% of the outpatient blood transfusion expenses incurred by insured children and college students due to illness are included in the accounting scope of the basic medical insurance serious illness pooling fund.
3. The maximum payment limit of the basic medical insurance pooling fund for each medical insurance year is linked to the number of years that the insured person has continuously participated in the basic medical insurance. The longer the continuous insurance period, the higher the maximum compensation limit.
The upper limit of children's outpatient medical insurance payment varies from region to region, and the problems are as follows:
1. If the expenses exceed the upper limit of overall payment, individuals need to bear certain out-of-pocket expenses or out-of-pocket expenses.
2, you can choose some commercial insurance to cover this part of the cost, in order to reduce the personal burden.
3. Pay attention to the local medical insurance policy and learn more about the specific provisions and reimbursement ratio of children's outpatient medical insurance.
To sum up, setting the upper limit of overall payment for children's outpatient medical insurance is to control the expenditure of medical expenses and prevent excessive medical treatment and abuse of medical insurance resources. However, in practice, due to the complexity of the illness and individual differences, sometimes there may be some special circumstances, which make the medical expenses of some patients exceed this upper limit. In this case, individuals need to bear more expenses, which may bring greater economic burden to patients.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 25
The state establishes and improves the basic medical insurance system for urban residents. The basic medical insurance for urban residents combines individual contributions with government subsidies. People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.