The scope and proportion of children's social security reimbursement

The reimbursement scope of general children's medical insurance includes outpatient medical expenses, special drug expenses and hospitalization medical expenses. There are four kinds of medical insurance reimbursement benefits that children can enjoy: 1. First, outpatient emergency reimbursement benefits. Within one year, the deductible line of outpatient and emergency medical expenses incurred by the insured in a first-class hospital is 800 yuan, with a maximum payment limit of 3,000 yuan and a subsidy of 30%. 2. The second is hospitalization medical insurance benefits. Within one year, the hospitalization medical expenses below 6.5438+0.8 million will be reimbursed differently according to the level of the hospital. First-class hospitals can reimburse 65% of hospitalization expenses, and there is no deductible; 300 yuan, the deductible line of secondary hospitals, can reimburse 60% of hospitalization medical expenses; 500 yuan, the deductible line of tertiary hospitals, can reimburse 55% of hospitalization expenses. 3. Three, outpatient special disease reimbursement treatment. For outpatient special diseases, the deductible standard within one year is 300 yuan, and the maximum payment limit and reimbursement ratio are calculated according to the reimbursement standard of the hospital where you live. Student accidental injury additional insurance benefits. 4. Fourth, students' accidental injuries are subject to additional insurance benefits. On the basis of basic medical insurance, students and children can add additional insurance for accidental injuries to solve the problems of medical expenses compensation, disability and death compensation caused by 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.

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.

Derivative problem:

How to handle the baby social security card?

The process of handling the social security card for newborns is: 1. Parents need to bring relevant materials (including newborn birth certificate, household registration book, local household registration certificate of one parent, etc.). ) go to the local street or village medical insurance service point to participate in urban residents' social security or the new rural cooperative medical system; 2 staff audit information, complete and meet the conditions for handling, can be handled on the spot; 3. The staff will enter the insurance information into the system; 4. Parents pay premiums in accordance with relevant regulations; Usually, the social security card will be completed within one month to two months. It should be noted that there are differences in the process of handling social security cards for newborns in different regions. Please consult the local authorities for details. Materials to be prepared for newborn enrollment: 1, the original household registration book where the newborn is located and copies of all pages (including the first page and the effective personnel information page). If the newborn's parents are not in the same household registration book, it is necessary to copy the other party's ID card (for example, if the newborn is settled with the mother, it is necessary to print the front and back of the father's ID card). 2. Registration certificate of all members of the household registration book (if the newborn's parents are not in the same household registration book, the other party's medical insurance registration certificate is required). 3. The original and photocopy of the medical certificate of birth of the newborn. 4. Original and photocopy of newborn birth certificate. 5. One-inch photo of the newborn (just take one with your mobile phone).