Here to help everyone figure out what is the nature of children's hospitalization funds and children's medical insurance? What problem can I solve? What is the relationship between the two? What are the guarantees? How to reimburse? To understand these issues, I recommend:
1) Go to the “Medical Insurance Network”: http://www.shyb.gov.cn/faq/listFaq.jsp is the most official and clear answer.
2) Hotline telephone 962218 (24-hour hotline, basically unable to get through during the day, basically open at night)
In summary, the above two insurances have been handled. Once the baby is hospitalized in the designated hospital in the district where the household registration is located, the reimbursement occurred during the hospitalization. The scope of the fee is directly deducted 50% (the child hospitalization fund) with the medical certificate at the time of discharge, and the other 50% is discharged to the local hospital (where the vaccination is located) before the hospital is discharged. Bill the remaining 50% directly.
So, is it necessary to consider buying insurance for your baby? There are the following points for your YY reference:
1) Both insurances only include the inpatient part, and the emergency department is not included. Therefore, if no parent can reimburse the baby for part of the medical expenses (usually 50%), it is necessary to buy commercial insurance to supplement this part. Of course, this refers to the door, emergency department, and the emergency department of the disease (such as a cold, fever) that is not included in the accident. This part of the cost is actually very low, tens to 100 pieces a year is enough. 2) If the location of the household (the area where the child's hospitalization fund is purchased) and the place where the baby's usual place of residence are not in a district, then if the baby is close to the hospital when he or she is sick, and there is no designated hospital in the place where the child is returning to the hospital, he is unable to enjoy the two insurances. of. Unless the hospital gives a referral certificate (and the procedure is said to be more complicated).
3) "Children's Hospitalization Fund" must be handled in September of each year. The baby school in kindergarten will be handled uniformly, but there is no baby going to school. Many parents only do the first year when the baby is born, if the second If you forget to renew or miss the time, you will not be able to enjoy the Children's Hospitalization Fund.
4) The major illnesses that can be reimbursed by the Children's Medical Insurance Institute are limited to five types, and the types of expenses are also regulated: including leukemia, hemophilia, aplastic anemia, radiotherapy and chemotherapy for malignant tumors, dialysis before kidney transplantation, and anti-surgery after surgery. The medical expenses of specialist clinics such as different treatments, and the outpatient expenses can only be paid 50% by the Children's Medical Insurance Fund (the “Children's Hospitalization Fund” involves only the expenses during the hospitalization period. The above-mentioned outpatient treatment expenses for outpatient major illnesses are not reported.) If you have child health insurance, do you need to supplement commercial insurance? I have inquired carefully about 962218 (medical insurance hotline). In terms of children's major diseases, children's medical insurance currently only bears the five kinds mentioned above, and the outpatient expenses can only be paid 50% by the children's medical insurance, and the remaining 50% is self-sufficient ( The remaining 50% cannot be reimbursed from the 60 fund because the 60 fund only covers the cost of hospitalization).
And they are all reimbursement properties, and all can only reimburse the expenses that belong to the scope of social security (imported drugs, self-funded medical treatment, treatment items are not within the scope of reimbursement). 60 is the children's hospitalization fund, which is of a social mutual aid nature. It is required to pay fees (60 per year); children's medical insurance is of a government nature, similar to the social security of adults, and does not require payment, but it is required to go to the household registration. The street ( ) medical institution (that is, the hospital that takes the vaccination) handles the registration procedures.
Some people say that if I buy commercial insurance again, I don't think it's worth it. I don’t think it’s worthwhile to look at it:
First, commercial medical insurance is actually a mutual fund, which puts everyone’s money together. If someone has a problem, they can get an emergency from this mutual fund. gold. Only the insurance company is a commercial financial institution. It must make money at the same time as taking risks, so it will certainly make certain risk control, such as exceptions to the history of the past, such as moral hazard (such as fraud insurance). Strict review, such as reimbursement of the nature of the insurance, the cost of self-funded drugs and unconventional treatment is not covered by the claims.
Otherwise, if anything can be reported, the insurance company must not blame, especially medical insurance. You think about it, a few hundred pieces of premiums a year, assuming thousands of dollars to tens of thousands of dollars in 30 years, a person in the past 30 years, even if they live in a hospital, they will almost earn back. Even in the past 30 years, there is no claim for a penny. It is normal for other people to spend tens of thousands and hundreds of thousands of hospitalization expenses in a serious illness. In fact, they are contributing their own money to those in need. In fact, if an insurance company does not sell life insurance and only sells that kind of additional medical insurance, it is definitely a loss.
Second, it depends on whether you are buying what you need, and whether you have existing social security, the benefits provided by the unit, or the existing commercial insurance. Relevant provisions for the grading payment of children's hospitalization funds: Article 12: 50% of the medical expenses incurred by primary and middle school students and infants due to the provisions of the preceding paragraph shall be reimbursed by the parent unit (or self-care), and 50% shall be paid by the mutual fund in accordance with the following provisions:
The ratio of the medical expenses of the series is
1 1000 (including 1000), the part 60%
2 1000 parts to the part of 5000% 70%
3 5000 or more to the part of 10000 80%
4 10000 or more part 90%
In each academic year, the maximum amount paid by the Children's Mutual Aid Fund is 80,000,862,610,861 for each elementary and middle school student, infant and child. The expenses for the children's hospitalization fund cannot be reimbursed: Article 13 The following medical expenses are not covered by the mutual fund:
(1) Fees for registration, meals, escorts and observation rooms, family beds, joint wards, rehabilitation wards, and social medical services.
(b) The cost of treatment in a prescribed medical unit.
(3) The expenses prescribed by the Health Bureau and the Medical Insurance Bureau shall be self-care.
(4) The part of the treatment expenses incurred as a result of injury caused by a third party shall be borne by the third party according to law.
(5) The cost of treatment for disability caused by participating in illegal activities will be popularized by everyone:
1) Emergency department: In one year, first use the money in the medical insurance account (current year + calendar year account) After the end of 1542, the part is 100% conceited, and part of the insurance coverage of 1542 is 50%
. 2) Hospitalization: <1542 Part: 100% conceited between 1542~61680 Part: 15% conceited, 85% social security reimbursement >61680 : 20% conceited, 80% social security reimbursement average hospitalization costs about 8000-10000 / times, so after accounting for a hospital social security reimbursement, you still need to bear at least 2500-3000 (because social security can only reimburse the social security scope of the cost, If you add non-social insurance coverage, treatment fees, etc., you need more)
3) outpatient illness: accumulate with hospitalization expenses, <61680 Part: 15% conceited > 61680 Part: 20% conceited now outpatiently ill The initial treatment cost should be at least 10-15 million, so if you have a major illness, you only need to bear at least 1. 70,000-2.7 million, plus a major illness will have a large self-funded expenses (such as imported drugs, better special treatments, etc.), plus follow-up treatment fees, care fees, etc., and can not work at home loss.
So it is necessary to supplement the medical expenses for major diseases with commercial insurance.