taipingyanglaobaoxiangufenyouxiangongsi
baofeixiangshougeshuiyouhui;buchangbuxianyibaomulu;gerenzhanghutouzijilei;jiankangguanliyufangweizhu;weixinlipeifangbiankuaijie。
toubaonianling:16zhousuiyishang,qieweimanfadingtuixiunianling mubiaorenqun:jiaonageshuiqieyouyibaorenqun
taipingyanglao“suishuikang”baohanabliangkuanchanpin,ji《taipingshengshigerenshuishouyouhuixingjiankangbaoxian(wannengxing)akuan》he《taipingshengshigerenshuishouyouhuixingjiankangbaoxian(wannengxing)bkuan》。
“suishuikang”baofeikeyixiangshougerensuodeshuiyouhui,juyoubaoegao、fanweiguang、tuposhebao、yunxudaibingtoubao、wudengdaiqidengtedian,tongshigerenwannengzhanghujuyouyidingtouzijiazhi。
“suishuikang”jiankangguanlifuwubaokuojiankangzixun、jiankangpinggu、manxingbingguanli,dianjiruxiadizhilejiexiangqing:
医疗保险责任 | 首次投保时未罹患既往症的 | 首次投保时已经罹患既往症的 | A款 | B款 |
---|---|---|---|---|
一、单个保单年度内医疗费用保险金额 | 20万 | 4万 | √ | √ |
(一)住院及前后门诊医疗费用保险金 | 20万 | 4万 | √ | √ |
其中,单一材料费用 | 3万 | 5000 | √ | √ |
(二)特定门诊治疗费用保险金 | 2万 | 5000 | √ | √ |
(三)慢性病门诊治疗费用保险金 | 3000 | 1000 | √ | - |
二、保证续保期间内累计医疗费用保险金额 | 80万 | 15万 | √ | √ |
医疗保险责任 | 基本医疗保险基金支付范围内费用 | 基本医疗保险基金支付范围外费用 | A款 | B款 |
---|---|---|---|---|
(一)住院及前后门诊医疗费用保险金 | 100% | 80% | √ | √ |
(二)特定门诊治疗费用保险金 | 100% | 80% | √ | √ |
(三)慢性病门诊治疗费用保险金 | 100% | 80% | √ | - |
案例一:
zhangxiansheng,25zhousui,suozaiqiyeweicanjiabuchongyiliaobaoxian,danweizuzhitoubao“suishuikang”akuan,zhangxianshengshouniannianjiaobaoxianfei2400yuan,qizhongfengxianbaofei329yuan,xiangshougaoeyiliaobaozhang,shounianbaofeikouchufengxianbaofeihoujinrugerenzhanghu,xiangshoufulizengzhishouyi,jiashewuchaefanhai,zhangxianshengdaoyixianianlingshiwannengzhanghujiazhiyanshiruxia:
ruoleijizhi30zhousui,wannengzhanghujiazhikeda11,596yuan(gao)、11,089yuan(zhong)、10,443yuan(di);
ruoleijizhi40zhousui,wannengzhanghujiazhikeda44,010yuan(gao)、38,514yuan(zhong)、32,326yuan(di);
ruoleijizhi50zhousui,wannengzhanghujiazhikeda91,720yuan(gao)、71,521yuan(zhong)、51,668yuan(di);
ruoleijizhi60zhousui,wannengzhanghujiazhikeda165,177yuan(gao)、 111,869yuan(zhong)、66,798yuan(di)。
案例二:
zhangxiansheng,25zhousui,suozaiqiyeweicanjiabuchongyiliaobaoxian,danweizuzhitoubao“suishuikang”bkuan,zhangxianshengshouniannianjiaobaoxianfei2400yuan,qizhongfengxianbaofei122yuan,xiangshougaoeyiliaobaozhang,shounianbaofeikouchufengxianbaofeihoujinrugerenzhanghu,xiangshoufulizengzhishouyi,jiashewuchaefanhai,zhangxianshengdaoyixianianlingshiwannengzhanghujiazhiyanshiruxia:
ruoleijizhi30zhousui,wannengzhanghujiazhikeda13,250yuan(gao)、12,674yuan(zhong)、11,941yuan(di);
ruoleijizhi40zhousui,wannengzhanghujiazhikeda52,744yuan(gao)、46,312yuan(zhong)、39,053yuan(di);
ruoleijizhi50zhousui,wannengzhanghujiazhikeda116,358yuan(gao)、91,941yuan(zhong)、67,761yuan(di);
ruoleijizhi60zhousui,wannengzhanghujiazhikeda217,326yuan(gao)、150,836 yuan(zhong)、93,736yuan(di)。
peifufanwei:yibaomuluneijibufenyibaomuluwaiyongyao
niandubaoe:jiankangrenqun20wan,jiwangzhengrenqun4wan
zhongshenbaoe:jiankangrenqun80wan/zuigao95wan,jiwangzhengrenqun15wan
peifubili:dancilipeibudiyu90%
weixinlipei:guanzhutaipingyanglaoguanfangweixin,zaixianqingsongwanchenglipei
xinxichaxun:denglutaipingguanwangwangshangyingyeting,suishichaxunbaodanxinxihezhanghuxinxi;guanwang“jiagegonggao”meiyuegonggaozhanghujiesuanlilv
kehurexian:quanguotongyikefurexian95589,tigongquannian365tian、7*24xiaoshiquantianhoufuwu
bengongsishengming:gailiyiyanshishijiyugongsidejingsuanjiqitajiashe,budaibiaogongsidelishijingyingyeji,yebudaibiaoduigongsiweilaijingyingyejideyuqi,zuidibaozhenglilvzhishangdetouzishouyishibuquedingde,shijibaodanzhanghuliyikenengdiyuzhong、gaodangliyiyanshishuiping。
benziliaojingonglejiechanpinzhiyong,jutiyingyitiaokuanjibaoxianhetongweizhun。