Proportion of hospitalization reimbursement for children's medical insurance in Suzhou

Legal analysis: 1. Outpatient medical subsidy: Insured students can enjoy 50% of outpatient medical subsidy from residents' medical insurance fund in 600 yuan every year if they meet the prescribed medical expenses in designated medical institutions with their medical cards.

2. Outpatient specific medical insurance benefits: After the medical examination and registration procedures are completed in hospitals and social security centers, outpatient specific medical expenses such as uremia dialysis, radiotherapy and chemotherapy for malignant tumors, aplastic anemia, hemophilia and severe psychosis can be directly transferred to designated medical institutions with my medical card, and the outpatient specific medical expenses for anti-rejection drug treatment will be paid in advance by individuals and then audited and settled at the municipal social security center in accordance with regulations in this settlement year. If the total cost of anti-rejection drugs for uremia dialysis, radiotherapy and chemotherapy for malignant tumor and organ transplantation is less than 200,000 yuan, the expenses incurred during the rehabilitation period of radiotherapy and chemotherapy for malignant tumor, aplastic anemia and hemophilia shall be paid by the residents' medical insurance fund according to the proportion of 90%, and the expenses incurred by mental patients using psychotropic drugs shall be paid by the residents' medical insurance fund according to the proportion of 90%.

Three. Hospitalization medical insurance benefits: insured students who need to be hospitalized due to illness can go through hospitalization procedures at designated hospitals in urban areas with medical certificates. The hospitalization Qifubiaozhun is 500 yuan, which exceeds the Qifubiaozhun. For the part below 40,000 yuan, the residents' medical insurance fund will pay 70% to 654.38+10,000 yuan for the part above 1 10,000 yuan, 80% to 200,000 yuan for the residents' medical insurance fund and 90% for the residents' medical insurance fund.

Note: In each settlement year, the accumulated medical expenses for specific items of hospitalization and outpatient service of insured students are capped at 200,000 yuan, and the medical expenses above the capping line will not be settled by the residents' medical insurance fund. Insured persons cannot enjoy social medical insurance benefits repeatedly.

Four. Medical assistance treatment: Students who meet the conditions of medical assistance can enjoy medical assistance treatment according to Suzhou Social Medical Assistance Measures on the basis of corresponding social medical insurance treatment.

Legal basis: Article 30 of the Social Insurance Law of People's Republic of China (PRC), the following medical expenses are not included in the payment scope of the basic medical insurance fund:

(1) shall be paid by the industrial injury insurance fund (2) shall be borne by a third party (3) shall be borne by public health (4) overseas medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.