Zibo Qihuibao 2022 reimbursement scope?
1. hospitalization medical expenses guarantee: deductible is 20,000 yuan (deductible for low-income poor people 1 10,000 yuan), insured amount is10.5 million yuan, 60% can be reimbursed below 50,000 yuan, and 70% can be reimbursed below 50,000 yuan,110,000 yuan. The reimbursement rate for students and children under the age of 22 is 70% below 50,000, 80% between 50,000 and 654.38+ 10,000 and 90% above 654.38+10,000. The reimbursement rate of personal expenses for seriously ill patients is 50%;
2. Outpatient specific high-priced drug protection: deductible is 20,000 (deductible of low-income poor people is 6,543.8+0.5 million), insured amount is 6,543.8+0.5 million, 60% below 50,000, 70% between 50,000 and 654.38+0.2 million, and 80% between 654.38 and 200,000. The reimbursement rate for students and children under the age of 22 is 70% below 50,000, 80% between 50,000 and 654.38+ 10,000 and 90% above 654.38+10,000. The reimbursement rate of personal expenses for seriously ill patients is 50%;
3. Protection for rare diseases: the deductible is 65,438+00,000, and the insured amount is 300,000, which can be reimbursed by 70%.
These include:
The guarantee of hospitalization medical expenses includes:
1. In-hospital medical insurance within social security: If the insured is hospitalized due to accidental injury or illness after the waiting period, the insurance company can reimburse the reasonable and necessary in-hospital medical expenses paid by the insured and within the scope of local basic medical insurance after deducting the total compensation for medical expenses obtained from public medical care, basic medical insurance for urban and rural residents and major illness insurance and the agreed deductible. If the insured begins hospitalization during the insurance period, but the treatment has not ended until the expiration of the insurance period, the insurance company may bear the corresponding insurance liability until the end of hospitalization, but the longest hospitalization shall not exceed 30 days from the date of expiration of the insurance period;
2. Medical insurance premium for outpatient and emergency treatment before and after hospitalization within social security: If the insured is hospitalized after the waiting period due to accidental injury or illness, the insurance company can deduct the sum of medical expenses compensation and agreed deductible from the reasonable and necessary medical expenses actually paid by the insured within 7 days (inclusive) before hospitalization and 30 days (inclusive) after discharge, which belongs to the scope of local basic medical insurance payment.
3. Social security special outpatient medical insurance premium: after the waiting period, the insured's special outpatient or chronic outpatient medical expenses caused by accidental injury or illness can be reimbursed by the insurance company after deducting the total compensation for medical expenses obtained from public medical care, basic medical insurance for urban and rural residents and serious illness insurance and the agreed deductible;
4. Hospitalization medical insurance premium outside social security: If the insured is hospitalized due to accidental injury or illness after the waiting period, the insurance company can reimburse the reasonable and necessary hospitalization medical expenses actually paid by the insured and beyond the payment scope of local basic medical insurance after deducting the deductible;
5. Outpatient and emergency medical insurance before and after hospitalization outside social security: if the insured is hospitalized after the waiting period due to accidental injury or illness, the insurance company can reimburse the reasonable and necessary medical expenses actually paid by the insured within 7 days (inclusive) before hospitalization and 30 days (inclusive) after discharge, which are beyond the payment scope of local basic medical insurance;
6. Medical insurance premium for special outpatient service outside social security: The medical expenses for special outpatient service or chronic outpatient service caused by accidental injury or disease can be reimbursed by the insurance company after the waiting period.
Outpatient specific high-safety drugs include:
Medical insurance premium for specific drugs: if the insured falls ill after the waiting period and is diagnosed by a specialist appointed or recognized by the insurance company as needing to use the drugs in the medical insurance premium drug list agreed in the insurance contract, the insurance company can reimburse the actual expenses incurred by the insured in the hospital or pharmacy designated by the insurance company that meets the requirements of the drug list after deducting the deductible;
Rare disease protection includes:
Proton heavy ion medical insurance premium: after the waiting period, the insured is first diagnosed as a serious malignant tumor or a mild malignant tumor agreed in the insurance contract by the hospital, and receives proton heavy ion radiotherapy in the proton heavy ion hospital. After deducting the deductible, the insurance company can reimburse the proton heavy ion medical expenses.
How to reimburse Zibo Qihuibao 2022 edition;
Zibo Qi Baohui can directly bring the claim materials to the main insurer Zibo Pacific Life Service Network to apply for a claim, and the insured can call 0533-3053000 to inquire about the claim.
It should be noted that Zibo Qihuibao 2022 began to accept claims on June 25, 2022, and the expenses incurred after hospitalization on June 25, 2022 met the insurance liability of Zibo Qihuibao 2022.
Zibo Qi 2022 version of the materials required to apply for claims include:
1. Apply for reimbursement of hospitalization medical insurance:
The insured/client shall fill in the Application for Insurance Claim and provide the following certificates and materials:
(1) Original medical expense voucher (original invoice or electronic invoice);
(2) Original medical insurance statement;
(3) Drug list (or electronic drug list);
(4) Hospital medical records (copied and stamped by the hospital);
(5) Copy of the insured's ID card and bank card and copy of the agent's ID card;
(6) In case of consolidated settlement of emergency transfer, emergency medical records, emergency medication details, emergency invoices and statements shall be submitted;
(7) If claims have been settled through other commercial insurance or other channels, a copy of the materials shall be provided and stamped with the official seal of the original retained unit;
(8) If the insured is a new citizen, you need to provide proof materials such as residence permit, unit certificate and student ID card when applying for claim settlement;
(9) When applying for family deductible, the insured shall provide proof materials such as household registration book and marriage certificate.
2. Apply for outpatient specific high drug expense insurance and rare disease drug expense insurance claims:
The insured/consignee shall fill in an application for payment of insurance benefits and provide the following certificates and materials:
(1) Personal insurance claim application form and receipt of claim application materials (filled in at the counter of the insurance company);
(2) Drug prescription (signed by the designated responsible physician), drug invoice (stamped by the designated pharmacy) and detailed list (including commonly used name, specification, unit price and quantity, etc.). );
(3) Other certificates and materials that can be provided to confirm the nature and cause of the insured accident;
(4) A copy of the insured's valid identity document and social security card or bank card.
Note: In addition to the above-mentioned documents and materials, a power of attorney of the insured, a valid identity certificate of the client and other relevant documents are required for entrusting others to apply for claim settlement.
Let's stop here about the reimbursement scope of Zibo Qihuibao 2022. I hope it will be helpful.