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

The reimbursement ratio of children's hospitalization medical insurance in Suzhou is as follows:

1. If the hospitalization medical expenses below 1.8 million yuan occur within one year, the first-class hospital will not set the deductible line and will be reimbursed by 65%;

2. 300 yuan, the deductible line of the secondary hospital, reimbursed 60%;

3, tertiary hospital deductible line 500 yuan, reimbursement of 55%;

Children's medical insurance card processing process:

1. The guardian (or child) logs into the online declaration system of children's medical insurance on the website of the Municipal Social Security Bureau, fills in the insurance information and prints the registration form;

2. The insured person submits the application materials to the social security agency in the place of residence, and the social security agency accepts the application materials, that is, enters the audit procedure;

3. Pay in the designated bank, and after the payment is successful, you will receive a certificate of personal payment of social insurance premiums;

4. After the processing is completed, you will receive the receipt and get the card 60 days later.

Medical insurance coverage:

1, reimbursement of basic medical insurance drugs: our country now divides drugs into three categories: A, B and C, of which A drugs are within the scope of medical insurance, so medical insurance can only reimburse A drugs, and B and C drugs cannot be reimbursed;

2. Reimbursement of basic medical service facilities: this reimbursement scope mainly refers to bed fees, first-aid bed fees, medical treatment fees, etc. Expenses incurred by the insured in the process of medical treatment and nursing in designated medical insurance institutions;

3. Reimbursement of basic medical insurance diagnosis and treatment items: it must be a safe and effective diagnosis and treatment item, and the charging standard shall be determined by the price department. Need to be treated in a designated medical institution.

To sum up, if the child is hospitalized or treated for special diseases, the individual will pay in advance, and the medical expenses incurred will be accounted for by the designated medical institutions. At the time of settlement, according to the regulations, 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.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.