Q&A on the treatment of children's medical insurance
(1) After the
Children's Medical Insurance is incorporated into the inpatient medical insurance, what is the starting time for the treatment?
Answer: The original Children's Medical Insurance Regulations stipulate that the insured person will enjoy the medical insurance for children from the month when the payment is made according to the regulations. After the children's medical insurance is incorporated into the inpatient medical insurance, the treatment enjoyment period is based on the hospitalized medical insurance, and the medical insurance benefits are paid from the full payment of the medical insurance premium.
(2) After the
children and college students participate in inpatient medical insurance, what are the outpatient treatments they enjoy? Is there a limit?
Answer: After children and college students participate in inpatient medical insurance, the expenses of outpatient (including emergency) in the bonded social health center or hospital are treated as follows:
1. Class A drugs and B in the basic medical insurance drug list The drugs are paid by the community outpatient co-ordination fund at a rate of 80% and 60% respectively;
2. If the individual items are under 120, the individual price is below 120, and the community outpatient co-ordination fund pays 90. %; if the individual price is above 120, it will be paid by the community outpatient co-ordination fund 120;
3. The insured person needs to be referred to the outpatient medical expenses incurred by other designated medical institutions by the settlement hospital due to the condition, or in the non-clearing hospital. The emergency medical expenses shall be reimbursed by the community outpatient co-ordination fund for 90% of the expenses paid in accordance with the provisions of the first and second paragraphs of this Article.
The outpatient medical (including emergency) expenses paid to each inpatient medical insurance insured by the community outpatient co-ordination fund within a medical insurance year, the total amount of up to 800.
Insured children and college students, the outpatient blood transfusion fee can be accounted for?
Answer: Yes. 70% of the outpatient blood transfusion fees for children and college students who are required to participate in the illness are included in the basic medical insurance major disease fundraising range.
What is the maximum payment limit for basic medical insurance?
Answer: The maximum payment limit for the basic medical insurance pooling fund for each medical insurance year is linked to the number of years in which the insured person participates in the basic medical insurance. The period of continuous insured for less than half a year, less than one year for less than one year, and less than two years for one year. For those who have been less than 3 years and less than 3 years, the maximum payment limit is 0.5 times, 1 time, 2 times, 3 times and 4 times of the average salary of the employees in the previous year.
(Note: At present, the government is studying to amend my medical insurance policy. After the government announces it, it will be implemented according to the new regulations.)(5) What is the maximum payment limit for local supplementary medical insurance benefits for children and college students? Specified? A: The maximum payment limit for the local supplementary medical insurance fund for each medical insurance year is linked to the time when the insured person continuously participates in the local supplementary medical insurance. The continuous insured period is less than one year after half a year, less than one year for less than two years, and full 2 The maximum payment limit is 50,000, 100,000, 150,000, and 200,000 for less than 3 years and less than 6 years, and there is no maximum payment limit for more than 6 years of continuous insurance. (6) Insured children and college students who suffer from major outpatient diseases can enjoy the medical insurance treatment for major outpatient clinics? What is the medical treatment for major outpatient clinics? A: Insured children and college students for dialysis of outpatients with chronic renal failure in outpatients, anti-rejection drugs for outpatients after organ transplantation, outpatient chemotherapy for malignant tumors, interventional therapy, radiotherapy or radionuclide therapy, hemophilia, aplastic anemia, Approved by the social insurance institutions, you can enjoy the medical insurance coverage of major outpatient clinics. The specific treatment is that 90% of the basic medical expenses incurred are included in the basic medical insurance major illness funded account, and the local supplementary medical expenses are paid by the local supplementary medical insurance fund at 80%. (7) In the outpatient clinic of the children's medical insurance, there was hemophilia and re-adhesive anemia. After being incorporated into the inpatient medical insurance, can these diseases also enjoy outpatient treatment? A: Yes. Children and college students participating in inpatient medical insurance are suffering from hemophilia and aplastic anemia. 90% of the basic medical expenses for specialist outpatient treatment are included in the basic medical insurance major disease pooling fund, and local supplementary medical insurance costs are supplemented by local governments. The medical insurance fund pays 80%. (8) What medical insurance benefits can I enjoy when I am enrolled in children and college students? A: The basic medical expenses and drug expenses for hospitalization for children and college students are included in the scope of the basic medical insurance drug list and the medical treatment items and general medical materials in the catalogue, and are listed in the basic medical insurance major disease pool fund accounting at 90%. range. (9) What is the hospitalization deductible line that needs to be paid when insured children and college students are hospitalized? A: Insured children and college students are hospitalized according to the level of hospital they live in. The hospitalization deductible line is also different. The number of hospitals in the first level and below is 100, the level in the second level hospital is 200, and the level in the third level hospital is 300. For 400. Insured children and college students transferred to hospital for treatment in different hospitals, respectively, calculate the hospitalization deductible line. (10) After a child participates in inpatient medical insurance, can the parental personal account that meets the original requirements be used to pay for the outpatient medical expenses of the child who participates in the child medical insurance? A: Yes. After children participate in inpatient medical insurance, if their parents' personal account accumulation reaches the average monthly salary of the employee in the previous year, the outpatient medical expenses of the children participating in the inpatient medical insurance can be paid. In this way, the outpatients who are insured for children are treated according to different situations: 1. Insured children can use their social security card.The bound fixed-point medical institution seeks medical treatment, and pays medical expenses according to the outpatient treatment regulations of the inpatient medical insurance. 2. When you are enrolled in a child's outpatient clinic and use your parent's personal account, you need to provide the parent's social security card at the time of medical treatment. In this way, the outpatient medical expenses incurred by the child will be paid from the parents' personal account, and will not occupy the children themselves. Outpatient co-ordination fund. (11) The method of incorporating medical insurance for children into hospitalized medical insurance is implemented on September 1, 2010. What is the treatment of the insured in September 2010? A: Because the original children's medical insurance year is from September 1st to August 31st and the insured person is entitled to the treatment in the month of the month, the new method is to participate in the insurance in September 2010, and the treatment will be enjoyed in October. Therefore, we have participated in the medical insurance for children who have participated in the medical insurance for children before September 1, 2010, and have already participated in the inpatient medical insurance in September. They can still enjoy the medical insurance for children and major outpatients during September 2010. The treatment prescribed in the Trial Measures. On the 10th of 2010, the hospitalization insurance benefits will be enjoyed. However, for the newly insured children and college students, the time for enjoying the treatment is the monthly payment, and the treatment can be enjoyed at the beginning. (12) How do the newborns of this household registration participate in the insurance, and how can their medical insurance benefits be enjoyed? A: Newborn insured is limited to the newborns in this household registration. The insurance and enjoyment benefits are divided into the following situations: 1. Apply for insurance within one month of entering the household, and provide birth certificate and motherhood. If a copy of the certificate is issued, the payment may be made from the month of birth and the medical insurance benefits shall be granted from the date of birth; 2. If the insurance formalities are completed within one month of the household registration, no birth certificate and a copy of the mother's ID card are provided. If you apply for the payment from the month following the application, you will receive medical insurance benefits from the next month of payment. 3. If you apply for insurance after 1 month, you will start to pay the fee from the month of application and enjoy medical insurance from the next month. treatment. (13) After the incorporation of medical insurance for children into hospitalized medical insurance, how does the original age of participating in child medical insurance be handled? A: After the incorporation of the medical insurance for children, the continuous insured life of the original child medical insurance can be combined with the insured life of the basic medical insurance for the insured person to participate in the inpatient medical insurance. The local supplementary medical insurance is based on the actual participation time. Calculation. This is because the children's medical insurance is basic medical insurance, and it has not participated in local supplementary medical insurance. Therefore, after the medical insurance is incorporated into the inpatient medical insurance, the continuous insured life can only be combined with the basic medical insurance years, but It cannot be considered as the insured life of local supplementary medical insurance. (14) The insured person has not handled the medical expenses for the hospitalization of the foreign hospital in the referral procedure, can he still be reimbursed? A: It can also be reimbursed. However, if the insured person fails to go through the formalities of transferring the certificates according to the regulations, if the inpatient medical expenses incurred by the medical institution outside the social insurance institution are in compliance with the scope of payment of the medical insurance fund, they may apply for reimbursement, but the reimbursement rate is reduced by 20%; If the inpatient medical expenses incurred by a non-fixed medical institution in a social insurance institution meets the scope of payment of the medical insurance fund, they may apply for reimbursement, but the reimbursement rate is reduced by 40%.