“Jiangsu Medical Benefits No. 1” claim settlement full month: Cardiovascular diseases and malignant tumors become “high incidence area”

2022-06-16 0 By

News from Xinhua Daily news · News from Jiangsu Provincial Bureau of Medical Insurance on February 9th, since January 7th this year, jiangsu Medical Benefit Insurance no. 1 opened the claim entrance, has paid more than 2.08 million yuan for 424 insured people.In terms of disease types, cardiovascular diseases and malignant tumors have become the “high-risk areas” for claims.Before the Spring Festival, 56-year-old Mr. Qu spent a total of 172,172.38 yuan in medical expenses during his hospitalization in Wuxi, and 48,915.28 yuan was paid by the basic medical insurance as a whole. The individual still needs to bear 118,845.11 yuan (including 115,227.53 yuan paid by the individual within the basic medical insurance and 3,617.58 yuan paid by the individual outside the basic medical insurance).According to the claim settlement agreement of “Jiangsu Medical Benefit Insurance No. 1”, the self-paid expenses in basic medical insurance can be claimed if they exceed the deductible by 10,000 yuan. Non-pre-existing patients with 0 to 100,000 yuan will be partially compensated by 65%, and the excess of 100,000 yuan will be partially compensated by 77%.This time, Mr. Qu received the compensation amount of “Jiangsu Medical Benefit Insurance No. 1” 100000×65%+(115,227.53-10000)-100000×77%= 69,025.20 yuan, which reduced the personal expense burden by 58% and became the largest single claim amount at present.As the first inclusive commercial supplementary medical insurance in Jiangsu province, the price of “Jiangsu Medical Benefit Insurance No. 1” is 158 YUAN per year. It is available to all insured persons in Jiangsu province without limitation of age, health status, medical history, occupation type, etc., and mainly provides four guarantees for insured people:One is to guarantee the part that the individual pays within the scope of basic medical insurance, the maximum compensation amount is 1 million yuan;Second, to guarantee the part beyond the scope of basic medical insurance, the maximum compensation amount of 1 million yuan;Third, the reinsurance for major diseases, the maximum compensation amount of 1 million yuan;Fourth, supplementary insurance liability for some major and special diseases, with a maximum compensation of 200,000 yuan.During the period of insurance, the expenses that meet the compensation scope of “Jiangsu Medical Benefit Insurance No. 1” can be claimed repeatedly within the insurance amount limit until the single insurance liability reaches the upper limit of claim amount.From the 424 claims that have been accepted, the age group of people in danger is concentrated in 50 to 79 years old, the oldest age of compensation is 91 years old, the youngest was only 6 months old.In terms of the site of occurrence, lung, stomach and liver were the most common malignant tumor sites in males, while lung, thyroid and breast were the most common malignant tumor sites in females.It is understood that “Jiangsu Medical Benefit Insurance No. 1” relies on AI, big data and other platforms to launch fast claim service, insurance participants can apply through the “Jiangsu Medical Benefit Insurance No. 1” wechat public account at the bottom of the menu bar, quick claim application only need to fill in personal information, no need to upload hospitalization documents, greatly simplify the claim application procedures.After receiving the claim application, the claim staff can complete the amount calculation only by retrieving the insurance data of the insured, which greatly shortens the claim time.Up to now, the cases of “quick compensation” account for 80%, which greatly relieves the financial pressure of the insured.Up to now, the number of “JIANGSU Medical Benefits No. 1” subscribers has exceeded 2.4 million.What needs to be reminded is that the centralized insurance period of “Jiangsu Medical Benefit Insurance No. 1” will end at 24:00 on February 28th, and all insured people in the whole province can apply for insurance through the wechat public account of “Jiangsu Medical Benefit Insurance No. 1”.Insurance on the same day, security effective at 0 o ‘clock the next day.Xinhua Daily · Intersection reporter Huang Hongfang