How to reimburse children's medical insurance in Beijing

Now more and more parents will buy children's medical insurance for their children, so how is the children's medical insurance in Beijing specifically reimbursed? The following is some information on how to reimburse children's medical insurance in Beijing. Let's have a look!

Q: What is the coverage of the medical insurance system for serious illness of students and children?

Answer: The scope of students' and children's insurance coverage: all registered students with non-agricultural household registration in this municipality who are enrolled in various ordinary colleges and universities (full-time academic education), ordinary primary and secondary schools, secondary vocational schools (including secondary specialized schools, technical schools, vocational high schools), special education schools, work-study schools, and non-school children (including kindergarten children, scattered infants and other non-school children under 0/6 years of age).

Q: What is the payment standard of the insured?

A: The funding standard of medical insurance for serious illness of students and children: 100 yuan per person per year (calculated by academic year), in which individuals or families pay 50 yuan; Financial assistance to 50 yuan.

Q: How do the insured pay the medical insurance premium?

A: All kinds of schools and kindergartens are responsible for the payment of medical insurance for registered students and children in our school, and pay the medical insurance premium for serious illness in one lump sum from July/KLOC-0 to September 30 every year according to the payment standard. Street (township) social security office is responsible for the participation and payment of medical insurance for serious illness of non-school children within its jurisdiction. Eligible non-school children can go through the insurance payment procedures by their parents at the street (township) social security office where their household registration is located, and pay the medical insurance premium for serious illness in one lump sum from June 1 day to August 3 1 day every year according to the payment standard.

Q: What benefits can special people enjoy when paying fees, and what proof materials do they need to show?

A: The urban elderly, students and children who enjoy the minimum living guarantee for urban residents in this city and the subsidies for the living difficulties of urban residents in this city, as well as the retirees who enjoy medical assistance according to the medical assistance measures for the urban poor in this city and the old activists who retire from neighborhood committees, are fully subsidized by the local district and county finances. Enjoy the city's urban residents minimum living security and living difficulties subsidies for urban elderly and students and children, need to hold my residence booklet and civil affairs departments issued within the period of validity of the "Beijing urban residents minimum living guarantee Jinling evidence", "Beijing urban residents living difficulties subsidy Jinling evidence" for insurance procedures, exempt from personal medical insurance premiums for serious illness. Referring to the medical assistance measures for the urban poor in this Municipality, retirees who enjoy medical treatment shall submit the Medical Manual for Retired Persons in Beijing; With reference to the medical assistance measures for the urban poor in this Municipality, retired old activists in neighborhood committees who enjoy medical treatment shall submit the Medical Certificate for Retired Old Activists in Beijing for insurance procedures, and shall be exempted from the medical insurance premium for serious illness that individuals should pay.

Q: What is the guarantee standard for the insured?

A: The threshold for reimbursement of medical insurance for students and infants with serious illness is 650 yuan, and the excess is reimbursed by 70%. The maximum cumulative payment for a medical insurance year is 6.5438+0.7 million yuan.

Q: What is the scope of medical reimbursement after insurance?

A: The medical insurance for students and children with serious illness mainly pays for hospitalization expenses; Outpatient medical expenses for taking anti-rejection drugs, hemophilia and aplastic anemia after radiotherapy and chemotherapy for malignant tumor, renal dialysis and kidney transplantation (including combined liver and kidney transplantation); Emergency rescue observation and income hospitalization, medical expenses within 7 days before hospitalization observation; Medical expenses for death within 7 days after emergency rescue observation. The medical expenses incurred must conform to the basic medical insurance of this Municipality and the medical insurance for serious illness of students and children, the catalogue of diagnosis and treatment items and the medical expenses within the scope of medical service facilities.

Q: What medical expenses are not covered by medical insurance?

Answer: those who seek medical treatment in non-designated medical institutions, except those who are hospitalized in emergency; Injuries caused by traffic accidents, medical accidents or other accidents; Drug abuse, fighting or other illegal acts cause injuries; Treatment for suicide, self-mutilation, alcoholism and other reasons; Treatment abroad or in Hongkong, Macao Special Administrative Region and Taiwan Province Province; In accordance with the provisions of the state and this Municipality, it shall be borne by individuals.

Q: When will I enjoy medical insurance reimbursement after I join the insurance?

A: Students and children take September 1 day to August 3 1 day as the year of critical illness medical insurance. Enjoy critical illness medical insurance from September 1 of the payment year.

Q: How does the insured seek medical treatment?

Answer: Students and children who are hospitalized or treated in outpatient clinics for special diseases will be paid in advance by individuals when seeking medical treatment, and the medical expenses incurred will be accounted for by designated medical institutions. At the time of settlement, the part paid by the serious illness medical insurance fund shall be settled by designated medical institutions and social insurance agencies, and the rest of the medical expenses shall be settled by individuals and designated medical institutions.

Q: How does the insured realize medical treatment and reimbursement in different places?

A: Students and children under the age of 16 who live or study in other provinces and cities should register for medical treatment in different places at the social security office where their household registration is located. They can choose two designated medical institutions at or above the county level or children's specialized hospitals and 1 designated medical institutions for medical treatment in this city. Medical treatment shall be carried out in accordance with the provisions of the scope of payment of medical insurance for serious illness in this Municipality, and the medical expenses incurred shall be reimbursed by the social security agency where the account is located. The medical expenses incurred by students and children in emergency hospitalization in designated medical institutions at or above the county level in the field that meet the scope of payment of medical insurance for serious illness in this Municipality shall be reimbursed by the social security office where their household registration is located.

Q: When will this medical insurance system be implemented?

A: Medical insurance for serious illness of students and children has been implemented since September 2007.

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