My son needs to be reimbursed when he is hospitalized. He purchased rural medical insurance, but the hospital said that the children’s mutual aid fund can be reimbursed at the hospital, and other insurances must be reimbursed locally. where should i go

(1) Children’s mutual aid fund, in 2014, was 70 yuan.

Reimbursement standard = (total hospitalization expenses - all out-of-pocket expenses - personal out-of-pocket medical expenses - minimum payment standard) * reimbursement ratio

Among them:

Minimum payment standard For townships, communities, and first-level hospitals, the fee is 100 yuan; for second-level hospitals, it is 200 yuan; for third-level hospitals, it is 500 yuan; and for referrals from outside the city, it is 1,000 yuan.

The reimbursement ratio is 92% for township and community hospitals; 85% for first-level hospitals; 75% for second-level hospitals; and 50% for third-level hospitals.

(2) Mutual aid supplement for serious illness, there are two levels in 2014, 150 yuan and 300 yuan.

Reimbursement standard = (total hospitalization expenses - all out-of-pocket expenses - minimum payment standard - part of the children's mutual aid fund that has been reported) * reimbursement ratio

Among them:

Minimum payment The standards are the same as above; the reimbursement ratio is 38.5% for 150 yuan (the maximum is not more than 400,000 yuan), and 77% for 300 yuan (the maximum is not more than 200,000 yuan). The fixed payment for liver disease and heart transplant surgeries is 40,000 yuan.

Newborn insurance can be purchased in the community after being discharged from the hospital. It will take effect immediately and will be valid until December 31 of the year of birth. September to December each year is the time to purchase children’s mutual aid funds for the second year (January 1 to December 31). If you participate in the critical illness supplement for the first time, there is a 6-month waiting period, which means that hospitalization within 6 months after purchase will not be reimbursed. After entering kindergarten, you can buy them all at the kindergarten.

So, it is not difficult to see that if the cost of hospitalization for a minor illness is not high, the major illness supplement does not show a big advantage, and is even less reimbursed than the children's mutual aid fund. However, once a serious illness occurs and hospitalization occurs, the cost is huge. The critical illness supplement shows a great reimbursement advantage, and it is recommended to choose the 300 yuan bracket (the maximum reimbursement is 400,000 yuan). If you buy hospitalization insurance from commercial insurance for your child, you will report it to the insurance company after both are reported (our company reports 100%, other companies have different proportions) to reduce your hospitalization losses. If you buy critical illness insurance from commercial insurance for your child, you will be able to get the insured amount paid by the insurance company when the diagnosis is made (the child can buy up to 400,000). After treatment, you will receive children's mutual aid and critical illness supplements when you are discharged. reimbursement, so there is no conflict at all. Mutual aid funds and commercial insurance can be purchased together for more complete protection.

The Xueping insurance purchased in kindergarten is actually a commercial insurance from a certain insurance company. It mainly covers reimbursement for accidental hospitalization and accidental outpatient services. Some also include reimbursement for hospitalization for diseases, but it is equivalent to group insurance. , so reimbursement is relatively low, and claims settlement will be more troublesome. It is recommended that if you have already bought hospital insurance and accidental medical insurance for your children from other insurance companies, there is no need to buy the school insurance again, because the reimbursement insurance is capped at the actual total cost. No matter how much you buy, it doesn’t matter. The reimbursement will not exceed your actual expenses.

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