Children's medical insurance regulations

Meets one of the following conditions and complies with the national family planning policy. All children should participate in the Children's Medical Insurance: all child care institutions, primary schools, junior high schools, high schools, secondary schools, technical schools established with the approval of the education, health, civil affairs, and labor security departments. There are children in vocational schools (excluding colleges and universities) and special schools (hereinafter referred to as “schools”). Among them, none of their parents should participate in this social insurance for more than one year. Social security calculation method. If you don't have a work unit or don't have social security, you can entrust to pay social security or social security.

The children who have not entered the school or settled outside, who have not settled for 18 weeks. The reporter learned from the Human Resources and Social Security Bureau that China Shipping Hospital, Shenzhen Union Hospital and Baoxing Hospital have become designated medical institutions for children's medical insurance. So far, the number of designated medical institutions for children's medical insurance has increased to 58.

The reporter learned that in addition to continuing to expand the number of medical institutions for children's medical treatment, the social security department will also step up the revision of medical insurance measures in accordance with relevant regulations, and will expand the medical institutions for children's medical care to the social health center, so that children can be swiped at the doorstep in the future. see a doctor.

The relevant person in charge of the social security department said that because the social welfare center could not carry out the inpatient business, the social security department did not set the social health center as a medical institution for children's medical care. At present, the bureau is also conducting the diagnosis and treatment of pediatric diseases in the social health center, and the level of diagnosis and treatment. In terms of research, the social health center that has the ability to undertake the diagnosis and treatment of children's diseases will be included in the scope of medical institutions for children.

The basic medical expenses are less than 5,000 (including 5000), the fund pays 80%; the 5,000 or less 10,000 (including 10,000) can be reimbursed 85%; the 10,000 or more can be reimbursed 90%. In addition, children's medical insurance is linked to the years of child and child insurance, the longer the time and the length of participation, the higher the reimbursement rate.

A threshold established to avoid hospitalization for minor illnesses and to ensure the effectiveness of insurance. According to the grades of fixed-point medical units, the thresholds are 300-600, including 300 for first-level hospitals, 400 for secondary hospitals, 500 for tertiary hospitals, and 600 for external referrals.