The national version of Huimin Bao - the national universal benefit insurance has returned from the original exemption of all pre-existing diseases to the current exemption of only 5 categories of specific pre-existing diseases, which is a substantial leap forward.
If there is no exclusive huimin insurance in the local area, you can consider participating in the universal universal universal insurance (upgraded version).
Through 10 questions, let's first take a look at how the upgraded version of the Universal Inclusive Insurance is.
1. What is the Universal General Insurance (Upgraded Version)?
Universal Universal Insurance (Upgraded Version) is a national basic medical insurance participants (must be insured state) can be insured by the people's insurance, the essence is still commercial insurance, underwritten by Yongan Property Insurance Company.
It can be understood as a "deleted version" of million medical insurance, which can reimburse the inpatient medical expenses inside and outside the medical insurance directory and 123 specific drugs.
2. Who can buy the Universal Inclusive Insurance (Upgraded Version)?
The universal universal general insurance (upgraded version) has a unified price, regardless of men, women, old and young, born 30 days to 60 years old, 199 yuan per year; 61 years old to 105 years old, 799 yuan per year.
- Unlimited age: whether newborn or centenarian, you can participate in the insurance;
- Unlimited occupation: whether it is a high-risk occupation or not, it can be insured;
- Unlimited household registration: regardless of where the household registration is located, you can participate in the insurance;
- Unlimited medical history: Without health information, illness can also be insured.
The only requirement: it must be an insured person in the insured state of basic medical insurance [employee medical insurance, resident medical insurance (including new rural cooperative)], and the resident Chinese mainland.
3. What is the Universal General Insurance (Upgraded Version)?
Yong'an People's Inclusive Insurance is divided into ordinary version and upgraded version, and the insurance liability is as follows:
It can be seen that the upgraded version of the Universal GeneralIzed Security Is a little more expensive, but the reimbursement rate is also higher.
As for the reimbursable range, deductible, and how to compensate, they are clearly written in the figure, and everyone must carefully look at the map
Special Note: Any expenses incurred in connection with a particular pre-existing condition will not be reimbursed!
4. How to reimburse the Universal Universal Insurance (Upgraded Version)?
In order to better understand how the Universal Universal Benefits Insurance (Upgraded Version) is reimbursed, let's take a simple example.
After the policy came into effect, Mr. Y was hospitalized for the first diagnosed lung cancer, with a cumulative cost of 400,000 yuan, basic medical insurance and major illness insurance reimbursement of 240,000, how much can the remaining 160,000 be reimbursed?
1. How is the remaining 160,000 made up?
The hypothetical details are as follows:
- The out-of-pocket expenses of individuals in the medical insurance directory are 30,000
- Out-of-pocket expenses outside the medical insurance list are 50,000
- Lung cancer specific high drug costs 80,000
2. How much can the remaining 160,000 be reimbursed?
According to the reimbursement rules:
The reimbursable amount of the out-of-pocket portion of the hospitalized individual in the medical insurance directory = (30,000 - deductible 20,000) × reimbursement ratio of 80% = 0.8 million
The reimbursable amount of the out-of-pocket expenses of hospitalized individuals outside the medical insurance list = (50,000 - deductible of 20,000) × the reimbursement ratio of 80% = 24,000
The amount of reimbursement for specific high drug costs for lung cancer = (80,000 - deductible 0) × reimbursement ratio of 80% = 64,000
In summary, the cumulative reimbursable amount = 0.8 million + 24,000 + 64,000 = 96,000
Of course, this does reflect the inadequacies of the universal universal insurance (upgraded version) of the benefit of the people: the reimbursement scope is narrow, the deductible is high, and the reimbursement ratio is low.
PS: The detailed protection plan can be found in the relevant content of the insurance interface, the reimbursement amount is subject to the actual situation, the above cases are only used for demonstration purposes, not as the basis for claims.
V. What are the specific high-value drugs?
The Universal Universal Inclusive Insurance (Upgraded Version) contains 123 specific high-value drugs, which can be referred to the "List of Specific Drugs" in the insurance interface.
Special reminder: The reimbursement of specific drugs must meet 4 conditions at the same time
- There are prescriptions issued by hospital specialists
- The medicines purchased belong to the specific drug list
- The drug is eligible for the applicable disease
- Purchase at designated pharmacies
6. Precautions for reimbursement of universal universal insurance (upgraded version).
1. If the insured person enjoys the treatment of local basic medical insurance, but does not use the reimbursement of the basic medical insurance to which he belongs, he will not be reimbursed.
2. Medical expenses incurred in the general department of a public hospital of the second level or above or in a designated pharmacy will not be reimbursed.
3. Work injuries, treatment of infertility, artificial insemination, pregnancy, miscarriage, childbirth (including difficult labor), induction of labor, abortion, birth control (including sterilization), prenatal and postnatal examinations and complications caused by the above reasons will not be reimbursed.
4. Medical expenses that should be borne by a third party shall not be reimbursed.
7. What does deductible mean?
Deductibles are also known as thresholds, i.e. insurance companies will reimburse them only if an agreed threshold is reached.
That is, medical expenses that meet the insurance liability need to be reimbursed by basic medical insurance first, and then deduct the corresponding deductible, and the remaining part is reimbursed according to the agreed proportion.
The GSP (Enhanced) deductible is an annual deductible, and the deductible will no longer be calculated for subsequent reimbursements during the same policy year when the accumulated medical expenses within the scope of insurance liability exceed the deductible.
VIII. Can the Universal GeneralIzed Insurance (Upgraded Version) be insured with illness?
Regardless of health status, you can bring illness to participate in the insurance.
However, the following major diseases that have been diagnosed before the initial application or before the non-continuous re-insurance will not be reimbursed.
(1) Tumors: malignant tumors - severe, malignant tumors - mild
(2) Liver and kidney diseases: renal insufficiency, cirrhosis, liver insufficiency
(3) Cardiovascular and cerebrovascular and glycolipid metabolism diseases: ischemic heart disease (including coronary heart disease, myocardial infarction), chronic cardiac insufficiency (cardiac function grade III and above), cerebrovascular disease (cerebral infarction, cerebral hemorrhage), hypertension (grade III), diabetes mellitus and accompanied by complications
(4) Lung disease categories: chronic obstructive pulmonary disease, chronic respiratory failure
(5) Others: systemic lupus erythematosus, paralysis, aplastic anemia, ulcerative colitis.
9. How to reimburse for medical treatment in different places?
Those who go through the filing or referral procedures for medical treatment in different places in accordance with the provisions of local medical insurance can still apply for compensation normally after being reimbursed by local medical insurance.
10. Does the Universal Inclusive Insurance (Upgraded Version) provide value-added services?
During the insurance period, the insured person suffering from major illness can enjoy the green channel service for medical treatment free of charge, including:
- Medical and health information consulting services
- Critical Illness Green Channel Service
- Hospitalization advance service for critical illness
- Public transport fee advance service for off-site referral of critical illness
- Medical escort service throughout the journey
These services are actually stronger than the benefits of the people in many cities, especially the hospitalization advance payment services for serious diseases, which can greatly alleviate the pressure on medical costs.
Of course, compared with the city's exclusive Huimin Bao, the price of the Universal Inclusive Insurance (upgraded version) is also a little more expensive, and you can choose according to your needs.
Again: if the health notice is met, age is met, budget permitted, and there is no exoneration of pre-existing conditions, it is recommended that millions of medical insurance be preferred, especially for children and young people.
Benefiting the people is a good policy, and it has indeed helped many families alleviate some of the pressure, but it is really not a long-term solution.
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