After taking out medical insurance, children can enjoy four kinds of treatment: hospitalization, emergency, outpatient special diseases and accidental injury additional insurance.
First, hospitalization medical insurance benefits. Within one year, the first-class hospital (community health service center) will not set the deductible line for hospitalization medical expenses below 6.5438+0.8 million yuan, and will be reimbursed 65%; 300 yuan, the deductible line of the secondary hospital, reimbursed 60%; 500 yuan, the deductible line of tertiary hospital, will be reimbursed by 55%.
The second is the treatment of reimbursement for special diseases in outpatient department. The deductible line for outpatient special diseases within one year is 300 yuan, and the highest payment limit and reimbursement ratio are implemented according to the hospitalization reimbursement standard. Special outpatient diseases include: renal dialysis, anti-rejection after renal transplantation, tumor radiotherapy and chemotherapy analgesia, diabetes, cor pulmonale, lupus erythematosus, hemiplegia, psychosis, hemophilia, anti-rejection after liver transplantation, epilepsy, aplastic anemia and chronic thrombocytopenic purpura.
The third is outpatient and emergency reimbursement. Within one year, the deductible line of emergency medical expenses incurred by urban and rural residents in first-class hospitals (including community health service centers) is 800 yuan, with the maximum payment limit of 3000 yuan and 30% subsidy.
The fourth is the additional insurance benefits for students' accidental injuries. On the basis of the basic medical insurance for urban and rural residents, a unified supplementary insurance for accidental injuries of students and children will be established to solve the problems of medical expenses compensation, disability and death subsidies for students and children due to accidental injuries.
Children's medical insurance reimbursement process:
Children's medical insurance reimbursement can be divided into the following situations:
1. Hospitalization: The basic medical expenses and local supplementary medical expenses incurred by the insured in designated medical institutions in the city or medical institutions outside the city (excluding overseas) can be reimbursed through children's medical insurance.
2. General outpatient medical treatment: the insured person is bound to a designated community health center in the city (/kloc-a hospital below the second level in the city can be selected under the age of 0/4) as an outpatient medical treatment point, where he can seek medical treatment. If the illness requires it, it will be referred step by step.
3. Outpatient medical treatment for serious illness: The expenses incurred by the insured person who suffers from serious illness and is approved by the municipal social security agency within the prescribed scope can be reimbursed through children's medical insurance.
I hope the above content can help you. Please consult a professional lawyer if you have any other questions.
Legal basis: Article 32 of the Trial Measures for Medical Insurance for Children's Hospitalization and Serious Illness Outpatient, if the medical expenses that meet the requirements of basic medical insurance occurred during the hospitalization and serious illness outpatient period of the insured need to be paid in cash, they can go to the municipal social security agency for reimbursement with relevant documents and materials: