How to reimburse Honghe Huimin insurance?

The claim method of "Honghe Huimin Insurance" is offline claim, and the insured can bring the relevant materials of claim to the offline branch of the insurance company service center to apply for claim. The main contents that can be guaranteed include:

1. The medical expenses in the medical insurance can be reimbursed 80% after deducting the deductible 1.3 million, and the previous illness can also be paid;

2.25 kinds of specific high-priced drugs can be reimbursed 80% after deducting the deductible 1.3 million, but the previous diseases stipulated in the insurance contract are not compensated, that is, malignant tumors (including leukemia and lymphoma).

"Honghe Prefecture Huimin Insurance" is an inclusive health insurance product guided and supervised by Honghe Prefecture Medical Insurance Bureau. Its original design intention is closely combined with the medical insurance policy, which complements each other. It is an exclusive product tailored for all medical insurance participants in Honghe Prefecture. Insurance is not limited to medical history, age, occupation and household registration. Each person only needs to pay 80 yuan premium every year, and the maximum compensation can be 6,543,800 yuan. The scope of responsibility includes not only the out-of-pocket expenses within the scope of medical insurance reimbursement, but also the expenses of 25 kinds of cancer-specific drugs.

"Honghe Huimin Insurance" is an urban customized product that meets the needs of insured people in Honghe and benefits more people. Adhering to the principle of "wide coverage, strong connection, benefiting the people and sustainable development", the project has the advantages of disease insurance, ultra-low price, millions of guarantees, and drug use for specific serious diseases. This project unifies the underwriting conditions, and does not distinguish the individual differences of the insured, such as social security status, age, past medical history and physical condition. Urban and rural residents and urban workers in our city can enjoy the rights and interests of ultra-low-cost insurance in 80 yuan, 80% out-of-pocket expenses within the scope of personal medical insurance reimbursement, 1 10,000 insured amount, 25 kinds of drugs for specific serious diseases, etc.

Yunnan Honghe Huimin Insurance is an inclusive commercial supplementary medical insurance jointly underwritten by China People's Property Insurance Company Limited, China People's Health Insurance Company Limited, China Life Insurance Company Limited, China Pacific Property Insurance Company Limited, China Dida Property Insurance Company Limited and Chengtai Property Insurance Company Limited.

Insured (including employees, farmers, students, etc.). ) In Honghe Prefecture, regardless of age, occupation and household registration, you can participate in "Honghe Huimin Insurance" at a uniform price, which can be used by men, women and children. There is no limit to the expenses within the scope of medical insurance, and patients with chronic diseases and serious illnesses can also participate in the insurance normally, and the compensation ratio is as high as 80%. Insured employees in Honghe Prefecture can also use the balance of the medical insurance card to pay for themselves and their immediate family members without paying cash.

Yunnan Honghe Huimin insurance is limited to those who have participated in basic medical insurance in Honghe Prefecture and are insured in the insured state. The main contents that can be guaranteed include:

1. The medical expenses in the medical insurance can be reimbursed 80% after deducting the deductible 1.3 million, and the previous illness can also be paid;

2.25 kinds of specific high-priced drugs can be reimbursed 80% after deducting the deductible 1.3 million, but the previous diseases stipulated in the insurance contract are not compensated, that is, malignant tumors (including leukemia and lymphoma).

legal ground

Notice of the Office of the People's Government of Honghe Prefecture on Printing and Distributing the "Fourteenth Five-Year Plan" for National Medical Security in Honghe Prefecture

Second, the development goals

According to the plan, by 2025, the Quanzhou medical security system will be more mature and stereotyped, and important mechanisms such as treatment guarantee, fund-raising operation, medical insurance payment and fund supervision will be basically completed, and the reform tasks in key areas such as medical service supply and medical insurance management services will be basically completed, and efforts will be made to achieve the construction goals of "fair medical insurance, legal medical insurance, safe medical insurance, smart medical insurance and collaborative medical insurance". Looking forward to 2035, Honghe Prefecture will basically realize socialist modernization in synchronization with the whole country and the whole province. Quanzhou's basic medical security system is standardized and unified, with basic medical insurance as the main body and medical assistance as the backing. The medical security system developed together with supplementary medical insurance, commercial health insurance, charitable donation and medical mutual assistance has become more mature, a unified and efficient medical security management service system has been established in an all-round way, and the collaborative governance pattern of medical insurance, medical care and medicine has generally taken shape. The advantages of China's characteristic medical security system are fully demonstrated, and the universal medical security is actively moving towards universal health security.

Three. The main contents of the plan

"Planning" consists of five parts. The first and second parts focus on the planning basis and overall thinking, and clarify the guiding ideology, basic principles and development goals of medical security development in Honghe Prefecture during the Tenth Five-Year Plan period. In the third part, the key development tasks put forward six aspects: improving the quality of universal medical insurance participation, promoting stable and sustainable financing operation, perfecting multi-level treatment guarantee mechanism, establishing effective and efficient medical insurance payment mechanism, perfecting strict and powerful fund supervision mechanism, and promoting the reform of medical service supply side in coordination. The fourth part, the construction of medical security service support system, puts forward three aspects: improving the ability and level of medical security service, promoting the informatization construction of medical security and implementing standardization work. The fifth part puts forward the safeguard measures of planning organization and implementation. At the same time, the "Planning" puts forward the implementation of the "eight major projects" in the form of a column around the five major medical insurance constructions of "fair medical insurance, legal medical insurance, safe medical insurance, smart medical insurance and collaborative medical insurance".

(1) As far as the main indicators are concerned. The plan defines the main indicators of medical security development in Honghe Prefecture during the Tenth Five-Year Plan period, and sets up six aspects, such as insurance coverage, fund guarantee, guarantee degree, refined management and quality service. The indicators are *** 17, which is consistent with the provincial planning indicators. By 2025, the participation rate of basic medical insurance in Quanzhou will be stable at over 95%; The proportion of fund payment within the scope of residents' serious illness supplementary insurance policy is not less than 60%; The proportion of hospitalization expenses paid by groups related to disease diagnosis and diseases accounts for 70% of all hospitalization expenses; Public medical institutions purchase drugs through provincial centralized procurement platforms, accounting for 90% of all purchased drugs (excluding Chinese herbal pieces); Public medical institutions purchase high-value medical consumables through the provincial centralized procurement platform, accounting for 80% of all high-value medical consumables; Realize centralized procurement of more than 500 kinds of national and provincial drugs and more than 5 kinds of high-value medical consumables; The inter-provincial direct settlement rate of hospitalization expenses reached more than 70%; The online availability rate of government services for medical security has reached 80%. At the same time, during the tenth five-year plan period, the income scale of the basic medical insurance fund is more suitable for the economic scale, and the expenditure scale is more suitable for the level of economic development and people's health needs. The proportion of hospitalization reimbursement for employees and residents within the scope of medical insurance policy, the proportion of hospitalization assistance for key relief objects in accordance with the provisions, the proportion of personal health expenditure to total health expenditure, and the availability rate of government service windows for medical security remain stable; The proportion of basic medical insurance funds in primary medical institutions has steadily increased.