It turned out that some time ago, Aunt Li was admitted to Shaw Hospital because of a heart attack. During hospitalization, the medical expenses * * * totaled 176504.68 yuan, and the reimbursement amount of basic medical insurance and serious illness insurance was 77696. 15 yuan, and the individual paid 98808.53 yuan in cash. Recently, "Yuehuibao" has further improved its treatment, not only expanding the indications of four "specific drugs" in terms of "responsibility", but also increasing "responsibility". Aunt Li also received more than 20,000 yuan in compensation.
It is understood that after Shaoxing's first customized commercial supplementary medical insurance "Yuehuibao" was launched, as of September 9, the participation rate of Yuehuibao in our district reached over 70%, ranking first in the city. The total amount of "one-stop" settlement payment of "Yuehuibao" is19,669,900 yuan, and the total number of payments reaches 13448. In order to better protect the interests of the insured, the relevant departments and insurance institutions have recently improved the product treatment and greatly expanded the scope of claims after many investigations and analyses. It not only meets the diverse medical needs of the masses, but also reduces the burden that some medical expenses cannot be included in the scope of medical security because of basic medical care, especially the seriously ill patients still have to bear higher medical expenses themselves. At present, the total number of people paying for Responsibility 4 has reached 9,320.
After this enhanced treatment, all claims expenses incurred by the insured since June+10, 5438 that meet the "Responsibility 4" can be reimbursed, and the insured does not need to apply separately. Claims will be pushed through the background data of the basic medical insurance system. From mid-August, the claims will be credited to the bank card account corresponding to the insured citizen card. After the payment is successful, the insurance company will call the patient or his family.
According to the relevant person in charge of Pacific Life, the fourth liability is the insurance liability increased according to the actual participation rate of "Yuehuibao" in 202 1. The insurance liability of "Yue Hui Insurance" will be adjusted according to the specific annual participation rate and the payout ratio of the previous year, including the insured amount, annual deductible, payment ratio and insurance amount. In order to ensure reasonable treatment and avoid overtreatment, a negative list has been made, including some plastic and cosmetic products and some expensive, alternative and unnecessary medical services and materials.
Related questions and answers: Where does Yuehuibao go to reimburse Yuehuibao? There are two ways to claim compensation: 1, and swipe the card on the provincial intranet. If the insured goes to the intranet medical institution in Zhejiang Province with the medical insurance card, the medical expenses will be settled at the time of discharge, and Yuehuibao will accept the expenses that meet the reimbursement conditions, and the insurance company will complete the reimbursement within 10- 15 working days. The reimbursement fee will be directly transferred to the bank account bound by the medical insurance card. 2. Sporadic reimbursement. Through the unified acceptance of the service window of the medical insurance center, one-stop reimbursement can be realized, and the insured person needs to provide a list of outpatient and inpatient drug expenses. If you go to a designated hospital outside the province, you can only use sporadic reimbursement. Yue Huibao: "Yue Huibao" is the first customized commercial supplementary medical insurance issued by the government in Shaoxing, which is specially developed for the basic medical insurance participants in Shaoxing (including Yuecheng District, Keqiao District, Shangyu District and Zhuji City of Shengzhou City). City and Xinchang County). The whole process is guided by government departments, and the premium amount, coverage and treatment standards are unified, which is seamlessly connected with basic medical insurance. Shaoxing City (including Yuecheng District, Keqiao District, Shangyu District, Zhuji City, Shengzhou City and Xinchang County) all basic medical insurance participants, regardless of gender, age, health status and type of insurance, can participate in "Yue Hui Insurance". Yuehuibao is mainly used as inclusive commercial supplementary medical insurance by China Pacific Life Insurance Co., Ltd. Zhejiang Branch, China People's Property Insurance Co., Ltd. Shaoxing Branch, China Life Insurance Co., Ltd. Shaoxing Branch, China United Property Co., Ltd. Zhejiang Branch and Ping An Endowment Insurance Co., Ltd. Zhejiang Branch. It has the characteristics of "zero threshold, serious illness, benefiting the people and excellent service". Shaoxing basic medical insurance participants only need to pay 100 yuan every year, and the maximum amount they can get is10.5 million yuan. Employee medical insurance participants can also purchase for themselves and their families (spouses, children, parents) through personal balance accounts over the years. The claim scope of Yuehuibao includes: 1. Out-of-pocket expenses and out-of-pocket expenses can guarantee the out-of-pocket expenses and out-of-pocket expenses of inpatients and outpatients who are reimbursed by medical insurance or serious illness insurance. No deductible, 50% can be reimbursed, and the annual maximum reimbursement is 500,000; 2. Reasonable treatment in designated hospitals, drugs and some materials can be reimbursed at their own expense. After medical insurance reimbursement, the deductible 1000 yuan is deducted, the remaining 60% can be reimbursed, 50% can be reimbursed for medical treatment in different places, and the maximum reimbursement within one year is 500,000 yuan; 3. Claims for expensive drugs purchased at one's own expense. A * * * contains 20 kinds of specific drugs, with the deductible of 1 000 yuan, and 60% can be reimbursed after deduction, with the maximum reimbursement of 500,000 yuan per year.