How to reimburse children's medical insurance

Legal analysis: Students and children who are hospitalized or treated in outpatient clinics due to special diseases shall be paid in advance by individuals when seeking medical treatment, and the medical expenses incurred shall 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. The annual fund-raising standard for children's medical insurance participants is 100 yuan, of which individuals only need to pay 50 yuan and the government subsidizes 50 yuan. For students and children who enjoy subsistence allowances, poverty alleviation, special care and severe disabilities, and all kinds of college students who enjoy national student loans, individuals do not pay fees and are fully subsidized by the government. After taking out medical insurance, children can enjoy four kinds of treatment: hospitalization, emergency, outpatient special diseases and accidental injury additional insurance. First, hospitalization medical insurance benefits. Within one year, the first-class hospital (community health service center) will not set the deductible line for hospitalization medical expenses below 6.5438+0.8 million yuan, and will be reimbursed 65%; 300 yuan, the deductible line of the secondary hospital, reimbursed 60%; 500 yuan, the deductible line of tertiary hospital, will be reimbursed by 55%. The second is the treatment of reimbursement for special diseases in outpatient department. The deductible line for outpatient special diseases within one year is 300 yuan, and the highest payment limit and reimbursement ratio are implemented according to the hospitalization reimbursement standard. Special outpatient diseases include: renal dialysis, anti-rejection after renal transplantation, tumor radiotherapy and chemotherapy analgesia, diabetes, cor pulmonale, lupus erythematosus, hemiplegia, psychosis, hemophilia, anti-rejection after liver transplantation, epilepsy, aplastic anemia and chronic thrombocytopenic purpura. The third is outpatient and emergency reimbursement. Within one year, the deductible line of emergency medical expenses incurred by urban and rural residents in first-class hospitals (including community health service centers) is 800 yuan, with the maximum payment limit of 3000 yuan and 30% subsidy. The fourth is the additional insurance benefits for students' accidental injuries. On the basis of the basic medical insurance for urban and rural residents, a unified supplementary insurance for accidental injuries of students and children will be established to solve the problems of medical expenses compensation, disability and death subsidies for students and children due to accidental injuries.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.

Seventeenth individuals who participate in the basic old-age insurance, due to illness or non-work-related death, their survivors can receive funeral grants and pensions; Persons who have completely lost their ability to work due to illness or non-work-related disability before reaching the statutory retirement age can receive disability allowance. The required funds are paid from the basic old-age insurance fund. .

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

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