1. Hospitalization fee: There is a "hospitalization fee outside medical insurance" in the guarantee content, which can only be paid after medical insurance claims are made, otherwise it cannot be reimbursed;
2. Specific high-priced drugs: There are certain restrictions on specific anticancer drugs outside the hospital, and they can only be paid after the diseases and indications to which the drugs are applicable.
3. Only the deductible can be reimbursed. The deductible of Shanghai Bao Hui is 20,000 yuan. If it doesn't reach 20 thousand yuan, you can only pay it yourself.
4. If you are hospitalized in the general department of the national second-class and above medical insurance designated hospitals and use the Shanghai medical insurance card for real-time settlement, you can apply for specific hospitalization expenses. If you don't use Shanghai medical insurance card for real-time settlement, you must go through Shanghai basic medical insurance settlement before you can apply for compensation.
5. For the self-funded medical expenses incurred within 30 days after the expiration of the insurance period, the insurance company will still pay the insurance premium according to the scope and proportion agreed in the contract. Those who continue to apply for the insurance in the following year are not subject to the 30-day limit.
6. Certain high-cost drug insurance premiums and proton heavy ion medical insurance premiums do not accept foreign/off-site claims.
The process is as follows
1, open WeChat;
2. Click on Lu Bao Hui at the top of WeChat homepage;
3. Click on the service center at the bottom of the home page-claim application appointment;
4. Select the type of reimbursement you want in the claim reservation, and then directly enter the application.
All participants in Luzhou basic medical insurance can purchase "Lu Huibao" and 89 yuan insurance for one year, with no age, health status, past medical history and occupation type restrictions, and no waiting period, with a maximum guarantee of 2.8 million yuan. The insurance period is from April 26th, 2022 to June 25th, 2022, and the guarantee period is from June 26th, 2022 to June 25th, 2023.
legal ground
People's Republic of China (PRC) social insurance law
Thirtieth the following medical expenses are not included in the basic medical insurance fund payment scope:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party. After the medical insurance fund pays in advance, it has the right to recover from the third party.