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Proportion of reimbursement for children's medical insurance cards in Shanghai

Legal analysis: Under normal circumstances, parents can enjoy four kinds of treatment: emergency treatment, hospitalization, outpatient special disease and accidental injury additional insurance after giving their children medical insurance. Among them, the reimbursement ratio will be different for different treatments, as follows:

1. Emergency reimbursement treatment. Within one year, the deductible line of outpatient and emergency medical expenses incurred by urban and rural residents in a first-class hospital is 8 yuan, and the maximum payment limit is 3 yuan, and the subsidy is 3%. 2. Hospitalization medical insurance benefits. According to different levels of hospitals, the reimbursement of hospitalization medical expenses below 18, in a year will be different. If the first-class hospital does not set the deductible line, it can reimburse 65% of the hospitalization medical expenses; The deductible line of the secondary hospital is 3 yuan, and the reimbursable hospitalization medical expenses are 6%; The deductible line of tertiary hospitals is 5 yuan, and 55% of hospitalization expenses can be reimbursed. 3, outpatient special disease reimbursement treatment. For outpatient special diseases, the deductible standard in one year is 3 yuan, and the highest payment limit and reimbursement ratio are implemented according to the standard of hospitalization reimbursement. 4. Additional insurance benefits for accidental injuries of students. On the basis of the basic medical insurance for urban and rural residents, it is suggested to provide unified additional insurance for accidental injuries of students and children to solve the problems of medical expenses compensation, disability and death allowance caused by accidental injuries of students and children.

Legal basis: Article 3 of the Social Insurance Law of the People's Republic of China, the following medical expenses are not included in the payment scope of the basic medical insurance fund:

(1) Those that should be paid from the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) It shall be borne by public health;

(4) seeking medical treatment abroad.

the medical expenses shall be borne by the third party according to law. if the third party fails to pay or cannot determine the third party, the basic medical insurance fund shall pay in advance. After the basic medical insurance fund has paid in advance, it has the right to recover from the third party.