Wenzhou yikangbao insurance coverage

The specific protection content of Yikangbao:

Responsibility 1: Ensure that the compliance expenses of hospitalization and special disease clinics are within the scope of medical insurance policy.

The maximum insured amount is 1.8 million, the deductible is 25,700, and the compensation ratio is 80%.

Responsibility 2: the reasonable cost guarantee for hospitalization and special disease outpatient service outside the medical insurance policy.

The maximum insured amount is 1.2 million, the deductible is 20,000, and the compensation ratio is 60%.

Responsibility 3: Deductible Exemption

According to the provisions of the first or second liability of this insurance, if the medical expenses of the insured exceed 6,543,800 yuan (inclusive), the deductible line of the corresponding liability shall be exempted.

Responsibility 4: outpatient drug guarantee in medical insurance catalogue

The maximum insured amount is 654.38+10,000, the deductible is 25,700, and the compensation ratio is 30%.

Responsibility 5: Special drug protection for special diseases (drugs that have been registered and approved for one year in China must be purchased at designated pharmacies).

The maximum insured amount is 450,000, deductible10.5 million, and the compensation ratio is 50%.

Wenzhou Yikang Insurance Compensation Method:

1, one-stop settlement

The medical expenses that the insured meets the claim conditions during the insurance period can be settled in one stop according to the provisions through the medical settlement data of the medical insurance information system after the payment period.

2. Sporadic reimbursement

If the medical expenses incurred by the insured person do not meet the one-stop reimbursement, sporadic reimbursement claims will be implemented. The insured can bring relevant materials to the special window of the branch designated by the insurance company for reimbursement.

Materials to be prepared:

Insured's ID card, inpatient medical record/discharge summary, pathological diagnosis report, drug prescription and approval form, immunohistochemical/genetic test report, etc.

Wenzhou Yikangbao medical reimbursement designated medical institutions should be comprehensive departments of public medical institutions of Chinese mainland level 2 and above and comply with the provisions of Wenzhou basic medical insurance; Wenzhou Yikangbao's designated pharmacies include Wenzhou Haoxi Pharmaceutical Retail Co., Ltd., Wenzhou Laoxiangshan Pharmaceutical Chain Headquarters, Wenzhou Yetongren Pharmaceutical Chain Co., Ltd. Nanguo Store, Yingte Yizhou (Wenzhou) Pharmaceutical Chain Co., Ltd. Attached No.1 Store, and Wenzhou Zhanghetang Pharmaceutical Chain Co., Ltd. Shenmuqiao Store.

Wenzhou Yikangbao needs to see a doctor at a designated medical institution or buy medicine at a designated pharmacy to be reimbursed. In addition, the reimbursement of special diseases and drugs in out-of-pocket expenses of individuals outside the medical insurance catalogue can only be obtained by purchasing drugs registered and approved in China for one year at designated pharmacies.