How to reimburse Xu's medical insurance

Xuzhou Hui Renewal Insurance Reimbursement Requirements:

1. Medical expenses reimbursed by medical insurance: The specific medical expenses incurred by the insured for hospitalization and outpatient service due to illness or accident shall be borne by the individual after medical insurance reimbursement in Xuzhou City (or where the insured's medical insurance is located). After deducting the annual deductible, it can be reimbursed by 60% (shared with China outpatient medical insurance for 6.5438+0.9 million), with a limit of 60%.

2. Reimbursement of outpatient expenses of drugs negotiated by the state: The expenses of 565,438+0 kinds of drugs negotiated by the state used by the insured in Xuzhou (or the place where the insured's medical insurance is located) due to illness or accident can be reimbursed according to 60% of the drug expenses that should be borne by the individual after medical insurance reimbursement after deducting the annual deductible (654,380+0.9 million with the medical expenses guarantee in the medical insurance).

3. Reimbursement of medical expenses outside medical insurance: The specific medical expenses incurred by the insured due to illness or accident that meet the medical insurance policy of Xuzhou City (or the place where the insured is located) and should be borne by the individual after medical insurance reimbursement can be reimbursed by 50% after deducting the annual deductible of 20,000, with a limit of 500,000;

4. Reimbursement of drug expenses for rare diseases: After deducting the 50,000-year deductible, the insured persons who are included in the guarantee mechanism for rare diseases in Jiangsu Province can reimburse 45% of the drug expenses that should be borne by individuals (limited to the insured persons of Xuzhou basic medical insurance), with a limit of 200,000.

First, the reimbursement method

1, apply online in "Xu Huibao", click "Personal Center Claims Service" in turn to report the case, take photos/scan and upload the claim information according to the prompts. Matters needing attention in online claim:

(1) The uploaded photos or pictures of claims data must be clear and complete;

(2) The signature of WeChat must be signed by the insured (or guardian);

(3) Please properly keep the original claim materials for subsequent insurance companies to collect and check;

(4) If you apply for claims for the deceased insured, only offline applications are supported. Please ask your family members to go to the claims service outlets of the underwriting insurance company.

2. Offline application: The insured can apply for the "Xu Huibao" project at the claim service outlets designated by the insurance company with relevant materials for claim settlement.

The reimbursement method of Xuzhou Hui is as follows: Hui can apply for reimbursement and claim settlement on the insurance platform, usually in the official account of WeChat, Xu Huibao.

Two. Hui Bao Xu's reimbursement scope includes the following contents:

1, medical insurance within the scope of medical insurance reimbursement, the highest claim can be 1 10,000 yuan, and the deductible is 20,000 yuan, and 60% can be reimbursed after deducting the deductible;

2. The national drug outpatient service guarantee can claim up to 1 10,000 yuan, with a deductible of 20,000 yuan, which can be reimbursed after deducting the deductible;

3. Medical insurance beyond the scope of medical insurance reimbursement can claim up to 500,000 yuan, with a deductible of 20,000 yuan, and can be reimbursed 50% after deducting the deductible.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance institution will give him some economic compensation.

The establishment and implementation of the basic medical insurance system has gathered the economic strength of units and social members. With the government's funding, sick social members can get necessary material help from the society, reduce the burden of medical expenses, and prevent sick social members from "poverty due to illness".

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. Safeguard citizens' right to get material help from the state and society in accordance with the law in old age, illness, work injury, unemployment and childbirth.

Article 28: Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29: The part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical trading units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.