Latest "Ping An Buddha Medical Insurance" 2022 first half claim report was released: As of July 31, 2022, the number of participants in "Ping An Buddha Medical Insurance" in 2022 was 953,300, and the annual claims for the 2022 policy exceeded 72 million, and in July only, with a claim of about 16 million yuan .
What are the high incidence types of people of different age groups?
What health suggestions can be obtained through data? Is
one-stop claim settlement convenient enough?
program live broadcast
This issue of "Free Travel" invites professional guests from Ping An Pension Insurance Company to help everyone sort out practical practical information in the field of claims!
Ping An Pension Insurance Guangdong Branch Deputy General Manager Zhu Xin
Minimum compensation case: Only 0.44 yuan? !
Insured Ms. Y was hospitalized in a Grade A hospital in Foshan City due to a fracture of right femoral neck . The total cost was 38,500 yuan, the medical insurance was 13,200 yuan, and the individual paid 25,300 yuan, and the total compensation of "Ping An Fo Medical Insurance" was 0.44 yuan, and of which 3,573.78 yuan was included in the medical insurance directory, which did not reach the deductible line. medical insurance directory included 20,000.74 yuan, with a deductible of more than 20,000 yuan, a claim of 0.44 yuan, and a total claim of 0.44 yuan. One-stop settlement.
Maximum compensation case: break one million! Ms.
D, 22 years old this year, started to participate in "Ping Anfu Medical Insurance" at the end of 2020, and participated in the insurance for two consecutive years. In October 2021, she was diagnosed with acute myeloid leukemia . After referral and filing, she went to a tertiary hospital outside the city for hospitalization. The total medical expenses are 2.212 million yuan, the medical insurance is coordinated to 700,000 yuan, the individual pays 1.522 million yuan, the total compensation for "Ping An Buddha Medical Insurance" is 1.1266 million yuan, , of which 744,900 yuan was included in the directory, 579,900 yuan was included, 679,600 yuan was included outside the directory, 395,800 yuan was included, and 247,700 yuan was included, and 151,000 yuan was included. The final total compensation was 1.1266 million yuan.
different age groups
"three major diseases" that threaten health
Through the half-year claims information statistics, we can learn from it "Ping An Buddha Medical Insurance" in 2022 The first three types of serious illnesses in different age groups are:
20 people under the age of age: congenital hearing loss, blood diseases, leukemia
Health advice: People under the age of 20 are in an important stage of physical development and are a flower cared for by their parents. Because their immunity is weak, you should be careful. Once you find that your child is discomfort, you need to seek medical treatment as soon as possible. Through claims data, we also found that children will suffer from congenital diseases with are more likely to suffer from congenital diseases than other age stages , such as congenital hearing loss, hemophilia, thalassemia, etc.; requires early detection and early treatment.
H blood diseases: including hemophilia, anemia, thalassemia, aplastic anemia limit and other blood diseases, and does not contain leukemia malignant tumors (same below).
20-40 years old: Breast cancer, blood diseases, leukemia
Health advice: People aged 20-40 are the pillars of society and family. They are busy with work and under great pressure, and often ignore health problems. Moreover, due to irregular lifestyles and long-term high pressure, they are more likely to be found by diseases. For people aged 20-40, must develop good living habits , which is not only responsible for oneself, but also for family members.
50 people over the age of 350: cardiovascular disease, cerebrovascular disease, respiratory disease and lung cancer
health advice: It is reported that cardiovascular disease has become the "first killer" that has taken the lives of the Chinese people, and is for middle-aged and elderly people This is even more true. cardiovascular and cerebrovascular diseases have a high incidence and mortality rate. . You must pay more attention in daily life. monitor cardiovascular and cerebrovascular related indicators . If there are diseases such as "three highs", must take medicine on time and review on time.
Note: Among them, respiratory diseases are common in various types of pneumonia (such as severe pneumonia, bronchial pneumonia, lung infection, etc.), chronic obstructive pulmonary disease, pulmonary nodules
One-stop claim settlement
Does insured persons need to run errands back and forth?
After one-stop claim settlement, the insured person does not need to run errands back and forth . It is aimed at the medical expenses incurred in the city's designated medical institutions for hospitalization, or selecting designated hospitals for specific outpatient diseases in the outpatient clinic to conduct medical treatment. After the designated medical institutions settle through the National Medical Insurance Information Platform, the expenses that meet the insurance liability of "Ping An Buddha Medical Insurance" will be settled in a "one-stop" way of benefits at the same time. insured persons do not need to apply for reimbursement of separately.
The key point is: What specific items can be reimbursed for by "Ping An Buddha Medical Insurance"? Can the remaining expenses be reimbursed through "Ping An Buddha Medical Insurance" after the medical insurance is reimbursed?
3 Hospital medical expense compensation :
1, within the scope of the medical insurance directory (including specials) personal compensation for medical expenses (20,000 yuan deductible, 80%)
2. Compensation for personal self-paid expenses outside the medical insurance directory (20,000 yuan deductible, 60%, no special protection)
3. Compensation for extremely high medical expenses in the medical insurance directory (range 10,000-500,000 yuan deductible, 90%; range 500,000-1 million, no deductible, 100% )
malignant tumors self-paid drug liability (range 10,000 to 300,000, 90% of non-previous symptoms, 60% of previous symptoms)
28 types of severe and serious diseases insurance (10,000 yuan, first time in the insurance year)
121 rare diseases insurance (10,000 yuan, first time in the insurance year)
You ask and answer!
Question
During the routine physical examination every year, my family and I both showed that there were thyroid nodules, breast nodules, fatty liver, hypertension and other conditions. Does it affect the insured?
Ans
does not affect. " Ping An Fo Medical Insurance " has no restrictions on household registration, age, or past medical history. As long as you participate in Foshan Basic Medical Insurance (insured persons who worker medical insurance or resident medical insurance), you can participate in the insurance regardless of whether you are healthy or not.
Q
I want to help my parents purchase "Ping An Buddha Medical Insurance". Can I use my medical insurance account to deduct the fees uniformly?
Ans
is OK. As long as the children and parents are Foshan basic medical insurance insured persons, they all meet the insurance requirements. The balance of my medical insurance account can be paid for myself and my immediate relatives (parents, children) who are also insured.
asked
where can I query my own insurance policy?
Ans
Follow "Ping Anfu Medical Insurance" WeChat public account-Personal Center-Insurance policy inquiry, and you can obtain policy information.
Follow the official account below
▼ to go to query▼
Ping An Buddha Medical Insurance "Ping An Buddha Medical Insurance" product is a Foshan citizen exclusive inclusive commercial supplementary medical insurance guided by the Foshan Municipal People's Government and jointly led by the Foshan Municipal Medical Insurance Bureau and the Foshan Municipal Social Insurance Fund Management Bureau.
Q
Social security has been suspended. Can I buy it if I receive unemployment benefits?
Ans
is OK. During the period when receiving unemployment insurance benefits, the unemployment insurance fund will purchase medical insurance for the unemployed, so you can purchase "Ping An Buddha Medical Insurance".
Ask
Can you enjoy "Ping An Buddha Medical Insurance" reimbursement when buying medicine in the pharmacy?
Ans
If you go to the pharmacy to buy medicine by yourself, you cannot claim compensation. Only the drugs that are self-paid for malignant tumors designated by "Ping An Buddha Medical Insurance" can apply for claims from "Ping An Buddha Medical Insurance" after meeting the qualifications.
Purchase of medicines
Q
purchased "Ping An Buddha Medical Insurance" and was hospitalized in Guangzhou. Can I be reimbursed?
Answer
If the insured person who has completed medical insurance referral registration or has been registered in a remote place (resident) for a long time (resident) for a different place, he can apply for a claim normally at a medical institution outside the city (only designated hospital for social medical insurance in mainland China) for medical records; the insured person can also apply for a claim normally due to emergency or rescue in hospitalization in medical institutions outside the city; The medical expenses transferred to the outside the city without referral registration will not be reimbursed.
So when you seek medical treatment in other places , please be sure to register first.
Question
What are the "specified hospitals" for the prescription of self-funded drugs for malignant tumors?
Ans
See the following picture:
(click the picture to enlarge and view)
program photo
Source: "Free Travel" program group
