What is the process and scope of reimbursement for children's medical insurance in Beijing in 2023?

Beijing children's medical insurance processing process, the scope of reimbursement for children's medical insurance is my finishing. If there is any change, please refer to the news released by official website. Children's medical insurance is a guarantee for medical expenses such as hospitalization, treatment and surgery caused by certain diseases reported by insurance. Now the basic medical care in China ... I want to know more about the handling process and reimbursement scope of children's medical insurance in Beijing. Let's take a look.

The process of Beijing children's medical insurance and the scope of reimbursement for children's medical insurance are sorted out. If there is any change, please refer to the news released by official website.

Children's medical insurance is a guarantee for medical expenses such as hospitalization, treatment and surgery caused by certain diseases reported by insurance. At present, China's basic medical system basically has a very low level of medical security for children. It is suggested that we can consider referring to some commercial security to reduce family risks.

Beijing Children's Medical Insurance Handling Process

"One old and one young" only applies to babies born in Beijing. Must be handled within 90 days after the child is born. There are no insurance procedures, and you can only go to the social security office to go through the insurance payment procedures for the next year from September of that year to 165438+ 10. Generally speaking, children do not enjoy any reimbursement treatment for the old and the young in the first year of birth. "One Primary School" only needs to pay 100 yuan each year, and can get the highest medical insurance of170,000 yuan, and can also enjoy a certain amount of outpatient and inpatient reimbursement. Novice parents must be clear!

First, the insurance time and place.

Newborns:

Within 90 days after the birth of a child, insurance will be applied from the month of birth to the end of the year. To emphasize that 90 days is not three months, because it may be 365,438+0 days for two consecutive months, so everyone must be accurate to the day, and must complete the household registration and apply for insurance within 90 days.

In 2007, one old and one small insurance was introduced. At that time, it was stipulated that within 90 days after the account was completed, the benefits would be enjoyed from the next month to the end of that year. However, a new document was released in July. Newborns must be insured within 90 days of birth and can enjoy insurance from the date of birth to the end of the year. This also relatively ensures that some babies will enter the incubator or other emergency medical treatment immediately after birth.

Renewal fee:

Except for newborns (including newborns who are not insured within 90 days), the centralized enrollment period is from September 1 day to June 1 65438+1October 30 every year, and the enrollment payment procedures are handled from June 65438+1October1day to the following year.

Handling location:

Infants (before kindergarten) are handled at the social security office of the street where the child's household registration is located; Those who are young and studying are handled by their kindergartens and schools.

More specifically, some children have to go to preschool for one year before they can go to school. Because preschool seems to be an institution that is not recognized by the state at present, this year's admission procedures have to be transferred back to the street social security office.

2. Payment amount and payment route fee 100 yuan/year.

Schools and kindergartens generally accept cash. In the street social security office, you need to apply for the debit card of Bank of Beijing or the postal savings passbook of the post office in advance (only these two types, other banks or other types of cards and discounts are not accepted). I suggest you apply for a debit card from Bank of Beijing, because in the process of our application, the child's name is a bit uncommon, and the postal passbook is often unsuccessful. It is ok to use the child's or parents' account name, because a column in the information registration form filled in by the social security office will indicate whether it is the child's own account name or the family member's withholding. You'd better deposit several hundred dollars more in this kind of deposit, and make sure to deduct enough every year, especially in June 10, June 1 10, and print the statement in time to see if the deduction is successful. If the balance is insufficient and the deduction is unsuccessful, you must pay the fee at the social security office in time before the end of June 1 1 to avoid payment failure.

In addition, if we catch up with the late stage of centralized insurance or for some special reasons, social security owners may ask for cash and cannot apply for bank withholding. In this case, parents must remember to change the way of bank payment in the street in the second year of centralized insurance, because it is easier and safer to transfer money from the bank. Now the jurisdiction is very large, and many streets have delegated the procedures for children to participate in insurance to neighborhood committees. Parents often don't even report the payment because of personnel transfer, unclear handover and negligence.

Reimbursement scope of children's medical insurance

Third, medical care.

Outpatient service: The deductible line is 650 yuan, and the excess is reimbursed by 50%, with a maximum reimbursement of 2,000 yuan per year.

Hospitalization: 650 yuan, deductible, 70% of the excess reimbursement, with a maximum annual reimbursement of 6.5438+0.7 million yuan.

Enjoy time: the outpatient treatment needs to be paid continuously for two years, and the newborns who are insured at the specified time can enjoy it in the current year, otherwise they will not enjoy the outpatient treatment in the next year.

Newborns insured within 90 days shall enjoy insurance from the date of birth to the end of the current year, and shall pay the insurance for the next year from September to165438+1October. Therefore, if the processing time happens to be September-1 1, parents must make it clear to the staff of the social security office that they have been insured for two years and their deposits in the bank or post office must be above 2 10 yuan.

Example 1:

The baby was born in March 1 and went to apply for insurance on May 20th. After successful payment, you can enjoy the medical treatment (including outpatient service and hospitalization) from March to February. If the bank deducted money at that time, remember to save enough money. 10 and 1 10 years, be sure to print the bank statement to see if there is any withholding of next year's insurance premium. If it is not deducted, you should go to the social security office in time to inquire. If the payment is made in cash on May 20th, you must also go to the Social Security Office for the next year's insurance payment from September to June 165438+ 10 (preferably registered as a bank account).

Example 2:

The baby was born on 20 18, 1, and did not go through the insurance procedures within 90 days. He can only go to the social security office to go through the insurance payment procedures for the next year from September to June of that year. Then the baby can only enjoy the hospitalization treatment of 20 18, but not the outpatient treatment. Only by continuing to pay fees on 20 18 can you enjoy the outpatient and inpatient treatment on 20 18.

Example 3:

The baby was born on August 1 day, 2065438, and went to the social security office to apply for insurance on August1day, 2065438 (belonging to the centralized insurance period). If it is a bank account, remember to deposit more than 2 10 yuan (it is best to deposit more than a few hundred yuan, and it is best to deposit enough directly before kindergarten), so we must emphasize social security. Cash also goes directly to 200 yuan. At present, the payment system has a silly default system. If you apply for insurance during the centralized insurance period, no matter whether you register for one year or two years, if your deposit is less than 20 1 yuan, only 100 yuan will be deducted. By default, it is next year, not that year! In this way, you don't belong to continuous payment, and children still can't enjoy all the treatment of the year and the outpatient treatment of the next year.

Example 4:

The baby was born on June 0, 20118, and it will take two years to apply for insurance at the social security office on June 6, 20 18. The reason is: if the newborn does not pay the fee in the year of birth, it will not be insured continuously, and it will not enjoy outpatient treatment in the second year! Some babies are born late at the end of the year. Parents don't think there will be any expenses these days, and hope to pay the expenses for the next year directly. But at present, the unified insurance system in the city is stipulated in this way. Even if you were born on June+February 3, 54381day, if you don't pay the fee in the first year of birth, you won't enjoy outpatient treatment in the second year! Therefore, for parents, it is quite cost-effective to pay 100 yuan and enjoy the outpatient reimbursement of 2000 yuan. Therefore, parents who are born at the end of the year should be specially reminded that they must be insured for 2 years!

Fourth, social security cards and choosing hospitals.

Children, like our employees, now have to open a social security card to see a doctor. However, the social security card is uniformly produced by the whole city. After collecting personal information, the street social security office reported it to the county social security center, which reported it to the municipal bureau. We can only do it after comparing it with the information of the public security system. Due to the influence of information comparison and accuracy of information collection, the progress of business card printing is not the same. Some can be done in a month or two, and some can't be done in a year. After the normal insured person enjoys the treatment, the expenses before issuing the card shall be borne by the family. After issuing the card, the cardholder will go to the street social security office with all the documents to handle the manual reimbursement procedures.

Five, medical insurance card hospital:

The top three hospitals, specialized hospitals and traditional Chinese medicine hospitals in Beijing can choose not to seek medical treatment directly (children's hospitals and children's research institutes belong to specialized hospitals), and the rest can also choose three designated medical institutions.

Beijing Basic Medical Insurance Class A Designated Medical Institutions

1, Beijing Tongren Hospital affiliated to Capital Medical University

2. xuanwu hospital of Capital Medical University

3. Beijing Friendship Hospital affiliated to Capital Medical University

4. Peking University First Hospital

5. Peking Union Medical College Hospital of China Academy of Medical Sciences.

6. Peking University People's Hospital

7. Peking University Third Hospital

8. beijing jishuitan hospital

9. Guang 'anmen Hospital, Chinese Academy of Traditional Chinese Medicine

10, Beijing Chaoyang Hospital affiliated to Capital Medical University

1 1, Peking University Shougang Hospital

12, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University

13, Beijing Tiantan Hospital affiliated to Capital Medical University

14, Beijing Millennium Monument Hospital (Beijing Railway General Hospital)

15, Beijing Gong Jian Hospital

Liangxiang Hospital, Fangshan District, Beijing 16

17, Beijing Daxing District People's Hospital

18, Beijing Shijingshan Hospital

Now it is a legal society, and many things closely related to life are inseparable from the law, so we should know some legal knowledge.