How to settle claims in Wenzhou Yikangbao Insurance?

Wenzhou Yikangbao is actually a universal commercial supplementary medical insurance product underwritten by commercial insurance companies and directed by government departments. Its insurers include PICC P&C Insurance, China Life Insurance, Pacific Life Insurance, Ping An Pension and Dida Insurance. The guiding units are Wenzhou Medical Insurance Bureau, Wenzhou Finance Bureau, Wenzhou Agriculture and Rural Bureau, Wenzhou Finance Bureau, Wenzhou Municipal Government Finance Office, Wenzhou Taxation Bureau of State Taxation Administration of The People's Republic of China, People's Republic of China (PRC), and Wenzhou Supervision Branch of China Banking and Insurance Regulatory Commission, China.

1. How does Wenzhou Yikangbao settle claims?

1 one-stop settlement

The medical expenses incurred by the insured during the insurance period that meet the claim conditions can be settled in one stop according to the provisions through the medical settlement data of the medical insurance information system after the payment period.

2. Sporadic reimbursement

If the medical expenses incurred by the insured person do not meet the one-stop reimbursement, sporadic reimbursement will be implemented. The insured can bring relevant materials to the special window of the branch designated by the insurance company for reimbursement.

Materials to be prepared: the insured's ID card, inpatient medical record/discharge summary, pathological diagnosis report, drug prescription and approval form, immunohistochemical/genetic test report, etc.

Wenzhou Yikangbao can reimburse the personal out-of-pocket expenses in the medical insurance catalogue: including hospitalization medical expenses (including special disease clinics), 80% can be reimbursed, and the maximum reimbursement can be 1.8 million yuan; Outpatient drug expenses can be reimbursed by 30%, and the maximum claim can be 654.38+10,000 yuan; In addition, Wenzhou Yikangbao can also reimburse personal expenses outside the medical insurance catalogue: including hospitalization expenses (including special disease clinics), which can be reimbursed by 60%, with a maximum reimbursement of 1.2 million yuan; Special drugs for special diseases can be reimbursed by 50%, with a maximum claim of 450,000 yuan; The special medicine guarantee for rare diseases can be reimbursed by 60%, and the maximum claim can be 65438+ 10,000 yuan. However, all the above claims have deductibles. For example, the deductible for outpatient drugs in the medical insurance catalogue is 25,700 yuan.

Second, under what circumstances does Wenzhou Yikangbao not pay?

1, medical expenses are not reimbursed by medical insurance.

If the medical expenses incurred by the insured can be reimbursed by medical insurance, but they cannot be reimbursed by medical insurance, then the insurance company will not compensate.

2. See a doctor or buy medicine in a hospital or pharmacy outside the agreement.

The designated medical institution of H-Kangbao refers to the general department of Chinese mainland second-class and above public hospitals that meet the requirements of Wenzhou basic medical insurance. In addition, there are regulations for pharmacies, including five designated pharmacies, which can be found in the claim statement of Yikangbao.

3. Other contents of the liability exemption agreement.