Infants with non-agricultural household registration in Beijing are eligible for insurance. In other words, you must first have a Beijing hukou (parents can also have a Beijing work residence permit), and then you need a town hukou, but agricultural registered permanent residence is not enough.
300 yuan's annual entry fee (policy changes every year).
Reimbursable expenses
Outpatient service: reimbursement deductible line 650 yuan, reimbursement ratio is 50%, capped at 3,000 yuan;
Hospitalization: the reimbursement deductible line is 650 yuan, and the reimbursement rate is 70%, with a ceiling of 6.5438+0.8 million.
For example, a baby spends 3000 yuan on outpatient service and 10000 yuan on hospitalization in a certain year.
Reimbursable expenses
= (2000-650)*50%+( 10000-650)*70%
=675+6545
=7220 yuan
650 yuan below the outpatient deductible line, above the capping line 1 000 yuan, and the remaining 50% need to be paid at their own expense; 650 yuan below the inpatient deductible line, 30% need to be paid at their own expense. The two deductible lines are calculated separately.
If you are a newborn (within 90 days of birth), the insurance period is from the date of birth to the end of the year. The advantage of being insured as a newborn is that the expenses incurred by outpatient service and hospitalization can be reimbursed from the date of birth; If you miss 90 days, you must apply for the insurance for the second year within the centralized insurance period between September1-June165438+1October 30 every year. At this time, only the hospitalization expenses of the second year can be reimbursed, and the outpatient expenses of the third year can only be reimbursed if the payment is continued in the second year.
Example:
A baby was born at sunrise on May 1 2065438.
Neonatal insurance
Payment and formalities: before 2065438+July 30, 2006.
Insurance period and content: outpatient and hospitalization expenses of May 2065438 +0, February 2065438+3 1.
Renewal premium: the premium for the second year is paid in September of 2016-1year, and outpatient and hospitalization expenses can be reimbursed in July of 2065438.
Centralized insurance
Payment and formalities: 2065438+September 1- 165438+20061October 30th.
Insurance period and content: expenses incurred during hospitalization in 201710/0/0/712312 months.
Renewal fee: the premium for the second year is paid from September to June of 20 1710/,and outpatient and hospitalization expenses can be reimbursed from September of 20 18.
Renewal fee: the premium for the second year is paid from September to June of 20 1710/,and outpatient and hospitalization expenses can be reimbursed from September of 20 18.
Handling strategy
1. Go to the police station to register your child. A "small" insurance can only be handled if you have an account.
We need to pay attention to the time limit here, especially when the baby enters pediatrics for various reasons after birth, and there is a clear demand for reimbursement. The time limit for children born in the first half of the year is not a big problem. The earlier you are born in the second half of the year, the better your household registration materials are. In case of special period, your social security card may not come down for three or five months.
Generally speaking, after the baby is born, the birth certificate can only be collected at the time designated by the hospital. Some parents don't have a good name in advance or want to refer to birthdates' name, and it may take ten or twenty days to complete the birth certificate. With the birth certificate, you can go to the police station to register.
The 90-day limit for newborn enrollment is accurate to days, not three months. If many months coincide with 3 1 day, it is actually less than three months, and it refers to the time when the materials are sent to the social security office. Generally speaking, the materials are handed over to the community neighborhood Committee, and then sent to the social security office by the neighborhood Committee staff. There may be a time difference of at least one or two days to one week, so many communities will stipulate to hand in materials within 80 days of birth.
2. Consult the community neighborhood committee for the required materials.
It's not that I don't want to give you a clear list of required materials. It's just that each community requires different materials and formats, so it's most convenient to go to the community for consultation. Generally speaking, the community will print a list of materials.
Although the requirements of each community are quite different, we can still give a general list for your reference.
1) The first page of the household registration book and my page.
Some communities require printing on the same A4 paper, while others do not. There are two copies, three copies, two copies on the first page and three copies on my page.
2) I recently took 1 or 2 one-inch bareheaded front color photos. Write the child's name or other necessary information on the back.
Note that photos must be developed, not developed, clothes should be dark, and there should be no strong reflection on the face. As for shooting equipment, there is no requirement. Just find a solid background at home (preferably white, not white with other solid colors, which is more convenient, P) and take photos with your mobile phone and send them to develop.
I used to need photos to see two ears. Fortunately, this abnormal requirement has been basically cancelled in the baby photos now. I didn't know how difficult it was to show two ears in the newborn photo until I took the photo, and sticking two pieces of paper behind the ears may not be successful.
3) A debit card of Bank of Beijing, a passbook of Postal Savings Bank or a savings card of Postal Savings Bank in the child's name, with a deposit of 1 000 yuan. Copy of card or passbook.
The differences between communities have once again become very large. . . There are designated debit cards from Bank of Beijing, designated passbooks from postal savings, or both. Deposit 1000, deposit 1200, others. Some copies require only the card surface to be printed, some require the balance of the passbook to be printed, and some require the parents' ID card to be printed on a piece of paper. Orz .。 . It's easy to open a card or discount. Just bring the identification of adults and children and tell the counter that an old man and a young man can open an account. Everybody knows.
4) Information Registration Form
Fill this out on the spot. If you can't remember the information to fill in, it's all in the materials you brought. In order to save processing time, you can also choose a designated hospital for your child in advance and check the code.
Children's social security card can choose 3 designated hospitals. Like the adult social security card, 19 tertiary hospitals, specialized hospitals (including children's hospitals and pediatric research institutes) and traditional Chinese medicine hospitals can be reimbursed without choice. One of the three self-selected hospitals must be a community hospital (it is recommended to choose the one closest to home, so that it is convenient to test blood in stool and prescribe some commonly used drugs at ordinary times), and the other two hospitals are also recommended to choose nearby. If there is a serious illness, 19 3A hospital is also recommended. If you really can't make up your mind, you can also consult the staff of the community site to see which hospitals most neighbors choose, and just follow suit.
QampA
Q: What is Q: 19 Grade III A hospital? Don't you have to choose a third-class first-class hospital?
A: 19 Class A hospitals refer to Beijing 19 hospitals whose medical insurance is not restricted by designated hospitals. 19 Most hospitals are Grade A hospitals, and there are a few Grade A hospitals, either Grade A hospitals or Grade A hospitals. The top three hospitals that are not within the scope of 19 should still choose if they need to be reimbursed for medical treatment. 19 list of hospitals: xuanwu hospital, Tongren Hospital, Beijing Friendship Hospital, Beijing Third Hospital, Peking University People's Hospital, Union Medical College Hospital, Jishuitan Hospital, Peking University Maternal and Child (Peking University First Hospital), Guang 'anmen Hospital, Beijing Chaoyang Hospital, China-Japan Friendship Hospital, Tiantan Hospital, Shougang Hospital, Beijing Traditional Chinese Medicine Hospital, Daxing District People's Hospital, Gong Jian Hospital, Fangshan District Liangxiang Hospital, Shijingshan. Including the branches or triage departments of these hospitals, such as huilongguan hospital in Jishuitan and Yuxin Clinic in the Third Hospital of Beijing Medical University.
Q: My child was born in June+February, 5438, and there is nothing to reimburse in the second month. Just pay the premium directly from the second year, right?
A: According to the regulations, newborns can directly enjoy outpatient reimbursement in the year of enrollment, otherwise they need to pay fees for two consecutive years to reimburse outpatient expenses. Although the enrollment in the second year does not exceed 90 days, the policy of enrollment as a newborn is from the date of birth. Otherwise, according to the unified enrollment cycle, the enrollment can only be from September to June every year +065438+ 10. That is to say, you can either apply for insurance from your birthday or wait until next September-1 1, and then you can reimburse the outpatient expenses from next year. Therefore, even children born on June+February 3, 54381day are advised to take out insurance that year.
But in fact, children born at the end of the year will indeed face such a possibility. If the child's social security card has not been completed before the end of the year, the medical expenses of the previous year will not be reimbursed. Generally speaking, the processing speed of social security cards varies from one month to half a year (in short, there is a relative shortage of births at the end of the year)
Q: What if I don't have a social security card to see a doctor?
A: You can take the materials to the social security office for manual reimbursement, but it is not recommended, because manual reimbursement requires the original social security card, and it will take about two or three months to come back. If you get sick again in the meantime, it will be endless. . .
Q: I moved. What if I want to change to a designated hospital?
Answer: You can go to any social security office in the city during the centralized insurance period from September/KLOC-0 to June 1 65438+1October 30 every year.
Finally, before September of each year, remember to ensure that the account balance is sufficient for deduction, at least more than the amount to be deducted 10 yuan before the deduction can be successful. For example, the annual premium 160 yuan must have at least 170 yuan in the account; Remember to check the account balance at the end of 10 to see if the deduction was successful. If it is unsuccessful, you should go to the social security office to find out the reasons before the end of 1 10 at the latest, and pay back in time, otherwise you can't apply for social security in the second year after the centralized payment period.