Weifang Huimin insurance reimbursement scope

Weifang Huimin Insurance provides inpatient medical insurance and outpatient medical insurance for chronic diseases, with a maximum reimbursement of 6.5438+0.5 million yuan. Provide hospitalization drug insurance benefits and high consumables insurance benefits outside the medical insurance catalogue, up to 500,000 yuan. Provide a certain amount of high drug cost insurance, and the annual compensation limit is 6,543,800 yuan. Provide insurance benefits for drugs with specific special effects, with a maximum reimbursement of 300,000.

The reimbursement scope of Weifang Huimin Insurance is as follows: 1. During the insurance period, the insured person is hospitalized in the designated medical institutions of Weifang Basic Medical Insurance due to illness and accidents, which meets the payment scope of basic medical insurance and is compensated by basic medical insurance and other benefits (excluding the part within the minimum threshold of basic medical insurance and the part paid in advance for medical treatment in different places).

2. Pay by installments, and deduct the deductible of 65,438 yuan+800,000 yuan from personal expenses. If the accumulated amount is less than 65,438 yuan+800,000 yuan (inclusive), the compensation ratio is 65%; For the part of 65438+ 10,000 yuan to 500,000 yuan (inclusive), the compensation ratio is 80%; For the part above 500,000 yuan, the compensation ratio is 95%, and the compensation limit is 6.5438+0.5 million yuan.

The way of reimbursement with medical insurance is as follows: 1, purchase medicine. You can take the social security card to a medical institution designated by medical insurance, or a pharmacy to buy medicine, and directly brush the social security card; 2. Outpatient service. It is necessary to keep the original proof of disease diagnosis, medical records and inspection reports issued by doctors, as well as the original outpatient expenses. You can directly reimburse the relevant amount by selecting social security card payment at the payment office; 3. Hospitalization. The reimbursement ratio depends on local conditions and project conditions. However, if an individual is hospitalized, he must pay the medical fee deposit in advance, and refund more and make up less after discharge. However, the medical expenses incurred before the hospitalization registration procedures are not included in the scope of reimbursement. Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. It is undertaken by the government and implemented and managed by economic, administrative and legal means. Social medical insurance consists of basic medical insurance and large medical assistance, enterprise supplementary medical insurance and individual supplementary medical insurance.

The reimbursement scope of Weifang Huimin Insurance is as follows: 1. During the insurance period, the insured person is hospitalized in the designated medical institutions of Weifang Basic Medical Insurance due to illness and accidents, which meets the payment scope of basic medical insurance and is compensated by basic medical insurance and other benefits (excluding the part within the minimum threshold of basic medical insurance and the part paid in advance for medical treatment in different places).

2. Pay by installments, and deduct the deductible of 65,438 yuan+800,000 yuan from personal expenses. If the accumulated amount is less than 65,438 yuan+800,000 yuan (inclusive), the compensation ratio is 65%; For the part of 65438+ 10,000 yuan to 500,000 yuan (inclusive), the compensation ratio is 80%; For the part above 500,000 yuan, the compensation ratio is 95%, and the compensation limit is 6.5438+0.5 million yuan.

Legal basis:

Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, standards of medical service facilities and medical expenses for emergency rescue, and shall be paid from the basic medical insurance fund in accordance with state regulations.