First, the out-of-pocket expenses within the scope of medical insurance policy are deducted from the hospitalization medical expenses 1. 70% for the deductible of 50,000 yuan, 50% for people with previous diseases 13, and the maximum insured amount 1 10,000 yuan;
Second, the out-of-pocket expenses of individuals outside the scope of medical insurance policy will be reimbursed by 40% after deducting the deductible line of 20,000 yuan, and by 30% for those with previous 13 diseases, with the maximum insured amount of 1 10,000 yuan;
Third, there are 25 kinds of specific high-cost drugs, the maximum insured amount is 1 10,000 yuan, among which 18 kinds of tumor-specific high-cost drugs cover high-incidence malignant tumors such as lung cancer, breast cancer and colorectal cancer, with zero deductible and 70% reimbursement; Specific drug expenses for seven rare diseases, including Gaucher's disease, Pompeii's disease, spinal muscular atrophy, mucopolysaccharidosis type ⅳ a, Fabry's disease, mucopolysaccharidosis type ⅱ and idiopathic pulmonary hypertension, are reimbursed at the rate of 25%. Even if you have the previous diseases of the corresponding diseases in the list of specific high-priced drugs in Huimian Insurance, you can also be reimbursed at a rate of 25%.
Notice on claims of Huimin insurance: process of claims for hospitalization medical expenses
1。 Report an accident
When the insured has an insured accident as agreed in the contract, please inform us within 10 days, and we will provide you with claims guidance services.
To report a case, please call Huimianbao's exclusive customer service hotline (4000-5599- 16) or pay attention to the official designated channel of Huimianbao and enter the claims service area to report the case.
2。 Claim application
In the process of inspection, treatment and accident treatment, please collect and properly keep the supporting documents and materials required for settlement of claims stipulated in the insurance contract in time.
Claim application method: You can apply for claim online or offline.
(1) Online application: enter the official designated channel of Huimianbao, enter the claim service area, and upload the claim data according to the prompts.
(2) Offline application: The applicant can bring relevant materials for claim settlement to the counter of the insurance company to apply for claim settlement.
3。 Acceptance and review
We will verify it within 5 days after receiving the application for insurance payment and the documents and materials agreed in this contract; If the situation is complicated, it shall be approved within 30 days. If the documents and materials provided are incomplete, we will promptly notify the applicant to supplement the relevant documents and materials.
4。 insurance expenses
For the insurance liability, we will fulfill the obligation to pay insurance benefits within 10 days after reaching an agreement with the beneficiary. For those who do not belong to the insurance liability, we will issue a notice of refusal to pay insurance benefits to the beneficiaries within 3 days from the date of approval and explain the reasons.
5。 Claim materials
As an applicant, the beneficiary of medical insurance benefits shall fill in an application for claim settlement and provide the following certificates and materials:
(1) Valid ID and account information of the insured; (If the insured is a minor, the identity certificate and relationship certificate of the guardian shall be provided at the same time. )
(2) Mianyang basic medical insurance statement;
(3) Admission and discharge records of the insured issued by the hospital;
(4) A detailed list of the insured's diagnosis certificate, medical expenses, prescriptions, tests and medical records issued by the hospital;
(5) The invoice of the insured's medical expenses issued by the hospital;
(6) If compensation has been obtained from other channels, it shall provide proof of obtaining compensation from other channels;
(7) Other certificates and materials that can be provided to confirm the nature and cause of the insured accident.
I hope the above content can help you. If in doubt, please consult a professional lawyer.
Legal basis:
Article 23 of the Social Insurance Law
Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations. Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.