Can Huhuibao clinic be reimbursed?

Huhuibao clinic cannot be reimbursed as follows:

1. Out-of-pocket medical expenses insurance premium for specific hospitalization: 20,000 yuan is exempted, 70% for those without previous diseases and 50% for those with previous diseases, with a maximum reimbursement of 6,543.8+0,000 yuan, of which the annual limit of single medical expenses is 300,000 yuan, which can be reimbursed for single hospitalization operation, local secondary hospitals and general departments of Shanghai medical insurance designated hospitals;

2. Insurance premium for certain high-value drugs in China: 0 free, 70% for those without previous diseases and 30% for those with previous diseases, with the highest reimbursement 1 10,000. Outpatients in Shanghai secondary and above hospitals or pharmacies with drug sales qualifications in Shanghai can be reimbursed. Generally, specific high-value drugs are purchased through specialized pharmacies that provide direct payment and home delivery services;

3. proton heavy ion medical insurance premium: 0 free, 70% for people with non-previous diseases and 30% for people with previous diseases, with a maximum reimbursement of 300,000. Medical hospital is a medical institution with proton and heavy ion therapy qualification in Shanghai, which generally refers to a hospital approved by the health administrative department of Shanghai to engage in proton and heavy ion therapy medical practice;

4. Overseas special drug expenses: 0 free, 70% for people with non-previous diseases and 30% for people with previous diseases, with a maximum reimbursement of 300,000, including Hainan Boao Super Hospital, Boao International Hospital, Boao Evergrande International Hospital, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Hainan Hospital and Hainan Boao Research Hospital;

5. Insurance premium for CAR-T drugs: free of charge, 65,438+000% for those without previous diseases and 65,438+000% for those with previous diseases, with a maximum reimbursement of 500,000 yuan. The insurance premium of CAR-T therapeutic drugs is limited by Fosun Kate Biotechnology.

Medical insurance reimbursement scope:

1. The insurance liability of hospitalization medical expenses within the scope of medical insurance, and the expenses that are still borne by individuals after some expenses in the medical insurance catalogue are reimbursed by basic medical insurance, serious illness insurance and medical assistance. , shall bear the liability for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,10.5 million free of compensation, the reimbursement rate is 80%, and the reimbursement rate for continuous participation is increased to 85%;

2. The insurance liability of hospitalization medical expenses outside medical insurance coverage, as well as the part that is still borne by individuals after the expenses outside the medical insurance catalogue are reimbursed by basic medical insurance, serious illness insurance and medical assistance, shall be liable for compensation within the agreed scope of insurance liability. 1 10,000 insured amount,1.8,000 free of compensation, the reimbursement rate is 60%, and the reimbursement rate for continuous participation is increased to 65%;

To sum up, in a word, its coverage does not include outpatient service, which cannot be reimbursed.

Legal basis:

Article 2 of People's Republic of China (PRC) Insurance Law

The term "insurance" as mentioned in this Law refers to the commercial insurance behavior in which the applicant pays the insurance premium to the insurer according to the contract, and when the insured dies, suffers from disability, illness or reaches the age and time limit agreed in the contract, the insurer shall be liable for the property losses caused by the possible accidents agreed in the contract.

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This Law is applicable to insurance activities in People's Republic of China (PRC).

Article 5

The parties to insurance activities shall exercise their rights and perform their obligations in accordance with the principle of good faith.