Shanghai Newborn Medical Insurance Policy in 2023

Shanghai's new * * children's medical insurance policy, the new * * children's medical insurance handling process is my finishing. This article is for reference only. If there is any change, please refer to the announcement of official website. The new children's medical insurance is actually residents' medical insurance, only for newborn babies born within 12 months. Babies can apply for a BB medical insurance card if they successfully enter the household ... If you want to know more about Shanghai's new medical insurance policy, let's take a look.

Shanghai's new * * children's medical insurance policy and the new * * children's medical insurance handling process are sorted out. This article is for reference only. If there is any change, please refer to the announcement of official website.

The new children's medical insurance is actually residents' medical insurance, only for newborn babies born within 12 months. Baby can apply for BB medical insurance card and enjoy medical insurance reimbursement after successfully entering the household.

Shanghai's New Children's Medical Insurance Policy

According to the residence insurance policy, Shanghai new * children will go through the insurance payment procedures after their household registration in this city, enjoy the residents' medical insurance benefits from the date of birth, and set up personal accounts from the next month of payment 1 day.

Medical expenses incurred from the date of birth to the date of account establishment can be applied for piecemeal reimbursement. Therefore, Mr. Jiang can bring the child's household registration book, agent's ID card, medical insurance card, medical record book, special receipt for medical expenses, relevant medical history data and copies to the neighboring district (county) medical insurance center or street medical insurance service point (accepting agent) for review and reimbursement within the specified time.

After the newborn participates in residential insurance, the outpatient and emergency medical expenses that meet the requirements of medical insurance in the community health service center (or a first-class hospital) shall be paid by residential insurance for 60%, and the medical expenses that meet the requirements of medical insurance in the designated hospitals of secondary and tertiary medical insurance shall be paid by residential insurance for 50%.

In addition, hospitalization (emergency care) for children living in residential insurance is designated by each district. Children in the domicile or in kindergartens, nurseries, schools, city, district (county) hospitals, township hospitals, street community health service centers are hospitalized, and they can enjoy 50% of their own medical insurance benefits with hospitalization settlement certificate and medical certificate.

Shanghai Xin 'er Medical Insurance Reimbursement Policy

According to reports, insured minors can choose a community hospital and a third-class first-class hospital as designated hospitals for outpatient and emergency treatment, and the basic medical expenses for general outpatient clinics in their selected community medical institutions will be reimbursed by 80%; In other designated medical institutions, designated hospitals and specialties, the basic medical expenses of general outpatient service will be reimbursed by 50%.

At the same time, if the newborn baby is insured within 3 months after birth, it can enjoy the corresponding medical treatment from birth; Students who were insured before June 3 1 of that year will enjoy the corresponding medical treatment from July 1 of that year.

At present, the medical insurance for children under the jurisdiction of Beijing streets has achieved full coverage, and children aged 0-5 are handled at the Labor and Social Security Center of No.7 Street, Yuehua Road. "Some hospitals can also help newborn babies." The person in charge said.

Social security experts said that minors and full-time students in primary and secondary schools should provide the original and photocopy of the household registration book, and newborn babies within 3 months after birth should also provide the original and photocopy of the birth certificate.

Secondly, it should be reminded that the specific reimbursement scope of neonatal medical insurance in different cities is different. Therefore, if you want to know the reimbursement scope of local newborn medical insurance, you may wish to log on to the website of local human resources and social security bureau to inquire about relevant policies, regulations or business guidelines, or call social security telephone 12333 for consultation.

Shanghai Xin * er Medical Insurance Handling Process

Frequently asked questions about medical insurance reimbursement

1. What materials should I bring for reimbursement?

(1) original invoice for outpatient service; If there are no specific diagnosis and treatment items and drug items on the outpatient invoice (items must include unit price and quantity), or if the items are incomplete, a complete list of outpatient medical expenses should be provided;

(2) Original hospitalization invoice; Summary of hospitalization medical expenses; Discharge summary or record (stage summary is provided in the middle of checkout, and death summary or record is provided by the deceased);

(3) the social security card of the insured;

(4) The local savings card or debit card with UnionPay logo of the insured person or agent in Xiamen (except CITIC, Minsheng, China Merchants Bank and credit card);

(5) If the non-insured person comes to handle it himself, the original and photocopy of the agent's ID card shall be provided;

(6) If the name of the invoice is mother's or father's name followed by "son" or "daughter", provide the original and a copy of the birth certificate (the original birth certificate should be filled with the new child's name before copying);

(7) If the name of the invoice is not the name of the newly insured child, nor is it the name of the mother or father followed by "my son" or "my daughter", it must be changed in the hospital, and the official seal of the hospital shall be affixed to the changed place; The names of vouchers such as expense list and discharge summary should be changed at the same time;

(8) When the mother is hospitalized during childbirth, if the hospital issues a separate invoice and summary table for the newborn baby, it can be reimbursed, but the mother's discharge summary (or record) must be provided;

(9) If the medical expenses span two social/medical insurance years, the expense list must be separated by year. For example, on June 20 18, 15, and July 0/0, when the insured paid medical insurance in both years, the summary list must be divided into two parts by year: 15 from June to June 30, and 1 year from July to 65438.

2. Is there a time limit for reimbursement of newborn medical insurance?

Yes All medical expenses incurred by the insured in a basic medical insurance year must be reimbursed within 3 months after the start of the next medical year (that is, before September 30); If the insured dies, his relatives shall settle the medical expenses within 3 months; Except for force majeure, the social insurance agency for overdue medical expenses shall not settle.

See Article 1 for the concept of basic medical insurance year. Medical expenses incurred during the period from July, 2065438 to June, 30, 2065438 shall be handled before September, 20, 2065438, and will not be reimbursed after the deadline.

3. Will the time of insurance and payment affect the reimbursement of new children's medical expenses?

Have an impact. Paying the cost of a medical insurance year does not mean that the medical expenses of the whole medical insurance year can be reimbursed. The specific requirements are as follows:

(1) If a new * child successfully goes through the insurance formalities in the local tax department where the household registration is located within three months from the date of birth and pays the corresponding insurance premium to the local tax account in the following month, the medical expenses incurred since birth can be included in the scope of medical insurance reimbursement.

(2) For those who apply for insurance after being born for more than three months, and pay the corresponding insurance premium to the local tax account in the month following the application for insurance, the medical expenses from the month of insurance this year can be included in the scope of medical insurance reimbursement.

(3) If you are insured three months after birth and fail to pay the corresponding insurance premium to the local tax account in the current month or the following month, you can only reimburse the medical expenses incurred from the month when the insurance premium is paid to the local tax account.

Special reminder: babies born in May and June each year are usually insured after July 1 day, spanning two medical insurance years. Therefore, when they apply for insurance, they should pay attention to the cost of two medical insurance years in order to enjoy the corresponding medical insurance benefits from the date of birth. For example, a baby born in May, successfully insured before August 3 1, often only paid the medical insurance annual fee (starting from July 1), which will lead to the expense reimbursement of the baby in May and June (belonging to the medical insurance year).