Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance institution will give certain economic compensation. The following is what I have compiled about the realization of universal health insurance in Shenzhen.

In 20 15, 20 yuan's critical illness insurance was introduced in Shenzhen, which made ordinary people pay little money and prevented poverty caused by serious illness through * * * *.

Shenzhen has achieved universal health insurance and built a three-level medical security system. Medical insurance plays a fundamental role in the linkage of three medical services by promoting the construction of graded diagnosis and treatment system, supporting the drug supply security system and deepening the reform of medical insurance payment methods. The implementation of smart medical insurance is a profound change in the medical insurance service model.

These all stem from the change of working ideas and concepts of government departments. Adapting to and keeping up with the new situation, constantly reforming and innovating, and extending medical insurance for medical insurance prevention are another innovation of ideas and exploration of systems.

The introduction of critical illness insurance has improved the medical insurance system.

Unfortunately, Mr. X is very ill. Fortunately, he not only participated in medical insurance, but also participated in supplementary insurance for serious illness, which reduced a lot of treatment burden. In addition to the normal medical insurance reimbursement, Mr. X received a personal compensation of 260,000 yuan for participating in the critical illness insurance. It is unfortunate to be seriously ill in life, and it is even more unfortunate if you are poor due to illness. In recent years, Shenzhen has been carrying out the reform and innovation of the medical security system, which has enabled the insured like Mr. X to establish a "firewall" through economic means.

In 20 15, 20 yuan's critical illness insurance was introduced in Shenzhen, which made ordinary people pay little money and prevented poverty caused by serious illness through * * * *. 20 yuan, personally speaking, is not much, but everyone collects firewood with a high flame, and four or five million yuan will guarantee a lot. Last year, more than 4 million people participated in critical illness insurance, and this year, more than 5 million people participated. To prevent serious illness from causing poverty, we must rely on everyone's supply to help each other. Last year, the maximum personal compensation for critical illness insurance was 260,000 yuan, and the first payment was 1.4 million yuan. This is of great help to the insured.

Shenzhen's medical insurance system has achieved full coverage, guaranteed low-level people and provided basic protection for the insured. Shenzhen's medical security system has three levels: first, basic medical insurance to achieve basic security and full coverage; Second, local supplementary medical insurance; The third is the supplementary medical insurance for serious and serious diseases undertaken by commercial insurance institutions. In the construction of medical security system, it is not enough to rely solely on the strength of the government, but also to cooperate with commercial institutions to complement each other and move towards a common goal and realize a multi-level social security system.

Shenzhen has been promoting the construction of medical insurance system, improving the mechanism of stable and sustainable financing and reimbursement ratio adjustment of medical insurance, further alleviating the social problem of poverty caused by illness and continuously improving the level of medical insurance protection.

Supplementary medical insurance for serious illness in Shenzhen is the livelihood of the municipal government 20 15. Shenzhen Human Resources and Social Security Bureau said that the supplementary medical insurance for serious and serious diseases adheres to the government's leadership, and is borne by commercial insurance companies through government procurement, and is responsible for its own profits and losses. This system covers the city's social medical insurance participants and adopts the principle of voluntary participation. Take the lead in adopting the multi-channel financing model of medical insurance account, personal expenses, welfare lottery and residual insurance fund in China.

However, the supplementary medical insurance for serious illness has a wide range of benefits and a high level, and 70% of hospitalization expenses can be reimbursed for the second time (without capping), and drugs such as lung cancer, breast cancer, intestinal cancer, leukemia, ankylosing spondylitis and schizophrenia can be treated 1 1 reimbursement. In addition, the implementation of one-stop claims service, insured people enjoy insurance benefits conveniently.

This reform has greatly reduced the medical and economic burden of patients with serious and serious diseases. From July, 20 15 to June, 20 16, 4.86 million people participated in the supplementary medical insurance for serious and serious diseases in the medical insurance year, and more than 30,000 people made claims, with a total compensation amount of 654.38+200 million yuan, and the highest single payment paid to the insured in the medical insurance year reached 735,000 yuan. From July 20 16 to June 20 17, the number of people participating in supplementary medical insurance for serious and serious diseases in the medical insurance year was 5.04 million. By September of 20 16, the total amount of claims was 454 1, and the total amount of compensation was 27.42 million yuan.

This reform provides more accurate and powerful medical security for the insured with serious and serious diseases, and effectively relieves the social problems of poverty and returning to poverty due to illness. This institutional innovation has realized for the first time that commercial insurance companies undertake Shenzhen policy medical insurance business through government procurement, introducing market resources and competition mechanism, greatly reducing the cost of insurance, effectively improving the security efficiency and promoting a win-win situation for all three parties.

Dare to explore and innovate, break through the financing mode of national serious illness insurance, Shenzhen actively adopts multi-channel financing to further expand the policy coverage, and at the same time activate the personal account of medical insurance and enlarge the guarantee function. Give special safeguard measures to special groups such as unemployed residents, orphans, entitled groups and severely disabled residents who enjoy the minimum living allowance, and practice the concept of precise poverty alleviation. Up to now, Qingyuan, Foshan, Zhuhai, Xiamen, Qingdao and other places have come to study and study critical illness insurance.

The linkage of the three medical institutions to reform medical insurance plays a fundamental role in inciting.

It is difficult and expensive to see a doctor because the opinions of the people are relatively large and the reform is difficult. The reform of medical and health system is to solve these problems. In order to promote the construction of "healthy Shenzhen" and give full play to the basic role of medical insurance in the reform of medical and health system, Shenzhen further promotes the linkage of medical care, medical insurance and medicine, and improves the ability of reform action.

In the linkage of three medical services, medical care and medicine are relatively static, and medical insurance is an active factor. It can also be said that medical insurance incites reform. For example, medical insurance plays an auxiliary role in basic medical and health security and can adjust the allocation of medical and health resources. Whether the insured person goes to a big hospital or a social health center can be adjusted through medical insurance. At present, 70% of the insured people require that the first outpatient visit be made in the community health center, while other insured people have no mandatory requirement, but they can get a 30% discount on seeing a doctor in the community health center, which can reduce the burden of large hospitals through the guiding role of medical insurance policy. There is also the management of designated medical institutions and retail pharmacies, which plays a role in coordinating the relationship between doctors and patients. The government's management of the whole basic health system can be achieved through the overall planning of medical insurance funds.

Medical and health care and social security are important livelihood undertakings in Shenzhen, including the "three-person project" to introduce talents and the joint reform of the three hospitals. In the "three-medical linkage" reform, medical insurance plays a fundamental role, which is reflected in several aspects. First of all, it bears the burden. From the point of view of Shenzhen, it is necessary to ensure the health and health of120 thousand population; Second, the load, 654.38+0.2 million people have problems with medication, and medical insurance needs to be allocated as a whole.

In the "three-medical linkage" reform, medical insurance instigates the reform through several fulcrums, including establishing and improving a multi-level medical security system and improving the level of medical security; Promote the construction of graded diagnosis and treatment system; Support the reform of drug supply guarantee system and medical service price system; Deepen the reform of medical insurance payment methods and strengthen the construction of medical insurance supervision mechanism.

For example, Shenzhen has achieved universal medical insurance at the policy level to ensure that the target of universal medical insurance is "guaranteed". 20 16, 10 In June, the number of participants in Shenzhen's basic medical insurance and local supplementary medical insurance reached127.97 million, up 6.3% year-on-year, of which the first, second and third grades of basic medical insurance were 3.943 million, 4.844 million and 40/kloc-respectively. Needless to say, Shenzhen's critical illness insurance was very successful as soon as it was launched, and the level of medical security was also steadily improving. In 20 15 years, the accounting ratio of hospitalization expenses within the scope of Shenzhen insurance policy was 88.9%, the actual accounting ratio was 82.6%, and the accounting ratio was also very high.

In order to solve the shortage of outpatient medical treatment in large hospitals and promote "minor illness in the community, serious illness in the hospital", Shenzhen Human Resources and Social Security Bureau has been insisting on guiding the insured to seek medical treatment at the grassroots level by implementing the medical insurance policy since 2005. The second-and third-level insured persons of basic medical insurance implement the method of "selecting the first social medical treatment and referring them step by step". At present, there are 8.74 million insured persons who have had compulsory first consultation, accounting for 70% of the total number of insured persons in Shenzhen.

The reform of public hospitals such as zero-addition treatment of drugs has attracted more attention. Shenzhen will cancel the reform of drug addition in public hospitals and expand it to the insured population in designated non-public medical institutions. After the insured people cancel the drug addition, the reduced drug addition income in designated hospitals will be converted into new outpatient fees and hospitalization fees, which will be paid separately by the social medical insurance fund, and the insured will not have to pay. From 2065438 to 2005, the Municipal Human Resources and Social Security Bureau * * * paid 469 million yuan for new outpatient and inpatient expenses in designated medical institutions, reducing the burden on the insured by 329 million yuan.

It can be seen that medical insurance plays a fundamental role in the linkage reform of the three hospitals. As Wang Wei, director of Shenzhen Human Resources and Social Security Bureau, said, no matter where any reform starts, medical care and medical care are the best.

Extend health insurance and realize the prevention of medical insurance in advance.

In the construction of medical security system, Shenzhen is an extension and expansion, extending medical insurance to medical insurance prevention. The Regulations of Shenzhen Special Economic Zone on Promoting National Fitness, which has been promulgated in Shenzhen, mentions that citizens are encouraged to actively participate in national fitness activities and establish an incentive system for citizens' fitness. If the balance of citizens' personal medical insurance account in the previous year reached 5% of the average wage of employees in this city in the previous year, 10% of the balance can be used for personal fitness consumption.

During the "Thirteenth Five-Year Plan" period, Shenzhen will play the preventive and health care function of medical insurance. For example, we will improve the catalogue of medical insurance drugs and medical services, and gradually include services such as combination of medical care and nursing, hospice care and rehabilitation care that meet the requirements into the scope of medical insurance payment, promote the partial balance of personal accounts of social medical insurance to be used for health service consumption such as physical fitness and preventive health care, explore the establishment of a "total control and balance reward" mechanism for medical insurance payment, and encourage medical institutions to promote graded diagnosis and treatment.

In the future, part of the balance of Shenzhen medical insurance personal account can be used for the consumption of health services such as physical health and preventive health care, so that the insured can enjoy more medical insurance policies that benefit the people.

Whether it is the introduction of critical illness insurance to improve the medical security system or the extension of health insurance for medical insurance prevention, it is an innovative reform in the development of medical and health undertakings and social security, an innovation in the concept of medical security and an innovation in the concept of government services.

Another innovation is also extremely important, that is, promoting the construction of "Internet plus medical insurance", using Internet technology to deeply change the service of benefiting the people, and providing a scientific basis for the formulation of medical security policies.

The smart medical insurance platform deeply changes the service model.

For a long time, some hospitals have the phenomenon of "three long and one short", that is, long queue time for registration, long waiting time for medical treatment, long queue time for taking medicine and short consultation time for doctors, which brings inconvenience to patients. In order to improve the queuing efficiency of registered payment and improve patients' medical experience, Shenzhen launched the pilot of mobile payment for medical insurance in June. At present, nearly 30 hospitals have participated in or applied to join the pilot project, and 10 hospitals provide mobile payment services for medical insurance, subverting the traditional medical treatment process and solving the problem of people seeking medical treatment.

Wang Wei, director of Shenzhen Human Resources and Social Security Bureau, said that the pilot work was jointly built by the Human Resources and Social Security Bureau, a number of Internet payment companies and pilot hospitals. With the help of payment technology and risk control system of mobile Internet companies, medical insurance and self-funded mobile payment can be completed with one click.

It is reported that after the pilot of mobile payment for medical insurance in Shenzhen, medical insurance participants can bind social security cards with financial functions through the payment platforms of partners, including Alipay, WeChat and Ping An Wallet, and then complete the registration and payment of medical insurance clinics through mobile phones to avoid long queues.

As of 20 16, 165438+ 10, 16, all payment platforms and social security cards have been successfully bound147,000 times, and 37,000 mobile payments have been made during medical treatment.

Shenzhen took the lead in promoting mobile payment for medical insurance in China, which is an important embodiment of improving citizens' medical experience and improving government service efficiency with the help of the Internet under the situation of "internet plus". Smart medical insurance construction uses internet technology to deeply incite medical insurance reform.

The smart medical insurance platform launched by Shenzhen Human Resources Security Bureau includes three systems: medical insurance intelligent audit system, actuarial decision analysis platform and insurance service platform. The medical insurance intelligent audit system is an intelligent medical insurance monitoring system that integrates pre-warning, intervention and post-audit to effectively monitor the fraud, waste and abuse of medical insurance funds, improve the efficiency of medical insurance audit and realize effective cost control. Promote the rationality of hospital's active management of medical expenses.

For example, the insured person can analyze the data as soon as he swipes the card to see a doctor. For example, in June 5438+10, an insured person went to the hospital three times and took a lot of medicine. This can be analyzed. How much medicine did he take? Is it reasonable to take medicine? It can effectively monitor more than 2,000 medical institutions and medical institutions. So is drug supervision, such as prescription drugs, whether pharmacies sell them to private people without prescription, etc.

The actuarial decision analysis platform is to analyze the operation, risk management and control, support ability and other data of medical insurance funds through the system platform and actuarial model. Provide scientific basis for scientific management and policy adjustment of the fund, and provide data support for policy evaluation and decision-making.

It can be said that through years of medical insurance system construction and continuous advancement of medical insurance reform and innovation, Shenzhen is weaving a perfect "security network" with almost no omissions, depicting the grand blueprint of Shenzhen's medical security system.

Extended reading:

Six basic functions of medical insurance in the linkage of three hospitals

In order to promote the construction of "healthy Shenzhen" and give full play to the basic role of Shenzhen medical insurance in the reform of medical and health system, Shenzhen further promotes the linkage of medical care, medical insurance and medicine, and improves the ability of reform action. Among them, medical insurance has played six basic roles:

First, build a multi-level medical security system.

Shenzhen's social medical insurance system has covered employees of Shenzhen units and residents with household registration in this city. At the same time, it also includes children and students who are not registered in Shenzhen, and has achieved universal medical insurance at the policy level. From August 2065438 to August 2006, the number of participants in Shenzhen's basic medical insurance and local supplementary medical insurance reached126.32 million, up 5.9% year-on-year.

Shenzhen has successfully established a three-level medical security system including basic medical insurance, local supplementary medical insurance and serious illness supplementary insurance. In 20 15, the number of people who voluntarily participated in supplementary insurance for serious illness was 4.86 million, and in 20 16, the number of people who voluntarily participated in supplementary insurance for serious illness was 5.04 million. By the end of 2065438+September 2006, there were 34,500 claims for supplementary insurance for critical illness, involving 1.26 million insured persons, with a total amount of 65.438+47 billion yuan, of which the maximum amount paid to individuals was 735,000 yuan.

In 20 15 years, the accounting ratio of hospitalization expenses within the scope of Shenzhen insurance policy was 88.9%, and the actual accounting ratio was 82.6%. The maximum compensation limit is linked to the continuous participation time. According to the standard of Shenzhen social wage of 6,753 yuan/month in 20 15 years, the maximum annual payment limit of the basic medical insurance pooling fund is 486,000 yuan, and the maximum payment limit of the local supplementary fund is 1 10,000 yuan.

Second, promote the construction of graded diagnosis and treatment system.

In accordance with the requirements of "first consultation at the grass-roots level, two-way referral, rapid and slow division and treatment, and linkage from top to bottom", we will solve the problem of medical shortage in outpatient departments of large hospitals and promote "minor illness in the community, serious illness in the hospital" At present, there are 8.74 million insured persons who have made compulsory first consultation at the grassroots level, accounting for 70% of the total number of insured persons in Shenzhen.

20 16 Shenzhen launched a pilot project in Luohu district. Luohu Hospital Group provides the basic medical and public health services stipulated by the policy for the contracted insured under the premise of not forcibly changing the medical treatment behavior of the contracted insured, and provides the contracted insured with the top ten quality services that benefit the people, such as family doctor, dynamic electronic health record management, priority diagnosis and treatment, chronic disease management, community rehabilitation and combination of medical care and nursing.

At the same time, reform the management mode of medical insurance expenses, and implement "total management and balance reward" for the total medical insurance expenses of contracted insured personnel. The balance of medical insurance fund can be used by Luohu Hospital Group for primary medical institutions to carry out business work and improve the treatment of primary medical personnel. This prompted Luohu Hospital Group to take the initiative to sink its resources to the grassroots level, strengthen the capacity building of community health centers and the signing service of family doctors, and guide the insured to do a good job in prevention and health care, so that the contracted objects will be less sick, less hospitalized, less burdened and optimistic about the disease.

Three, support the reform of drug supply security system and medical service price system.

The reform of canceling the drug addition in public hospitals will be extended to the insured population in designated non-public medical institutions. After the insured people cancel the drug addition, the reduced drug addition income in designated hospitals will be converted into new outpatient fees and hospitalization fees, which will be paid separately by the social medical insurance fund, and the insured people do not need to pay. In 20 15, Shenzhen Human Resources and Social Security Bureau paid 469 million yuan for new outpatient and inpatient expenses in designated medical institutions, reducing the burden on insured persons by 329 million yuan.

According to the requirements of "total control, structural adjustment, rising and falling, and gradually reaching the designated position", the inspection service price of large-scale equipment and the additional cost of medical consumables will be reduced, and the medical service price reflecting the technical service value of medical personnel will be increased.

Fourth, deepen the reform of medical insurance payment methods.

The reform of medical insurance payment method is conducive to improving the two functions of medical insurance: controlling medical expenses and regulating medical resources. At present, Shenzhen adopts a compound payment system under the control of total amount, including various payment methods, such as by unit, by disease, by head, by hospitalization days, by project and so on. And formed a unique payment model. Outpatients in Shenzhen mainly pay by head, and hospitalization mainly pays by unit and disease. The reform of medical insurance payment method covers all designated medical institutions, and gradually inclines to pay by disease. The number of diseases paid by diseases is 13 1. In addition, Shenzhen will explore the reform of DRGS according to the group payment method related to disease diagnosis.

At the same time, strengthen medical insurance supervision and control unreasonable medical expenses. For example, the supervision of medical insurance on medical services in medical institutions has been extended to the supervision of medical service behavior of medical personnel. 20 10 write the management of medical insurance doctors into the medical service agreement of designated medical institutions, and establish the database of medical insurance doctor management. By the end of 20 15 and 12, more than 20,000 doctors with social security agreements had registered.

Verb (abbreviation of verb) promotes the construction of "Internet plus medical insurance"

In order to facilitate the insured's medical treatment, the insured can use the social security card to keep accounts in all designated medical institutions in the city, and the expenses are directly settled by the social security institutions and designated medical institutions, and the direct settlement funds account for more than 99% of the insured's medical insurance payment funds. 20 16 In mid-June, Shenzhen Human Resources and Social Security Bureau joined forces with payment platforms such as WeChat, Alipay and Ping An Easy Wallet, and 17 pilot hospital * * * launched the mobile payment service for medical insurance. By binding the payment account of the payment platform with the social security card, mobile payment can replace the traditional offline credit card payment method and save the time for the insured to queue up by swiping the card. At present, nearly 30 hospitals have participated in or applied to join the pilot project, and 10 hospitals have provided mobile payment services for medical insurance. As of 20 16, 165438+ 10, 16, all payment platforms and social security cards have been successfully bound147,000 times, and 37,000 people have received mobile payment treatment.

Building an intelligent medical insurance audit system on the existing medical insurance information platform can realize the intelligent medical insurance monitoring of the whole process of medical behavior of medical institutions and insured persons before, during and after the event, and promote the self-management and behavioral norms of medical institutions. At the same time, we will build an information platform for actuarial decision analysis of medical insurance and carry out big data analysis to provide scientific basis for scientific management and policy adjustment of medical insurance funds, and provide data support for medical insurance policy evaluation and decision-making.

Six, encourage and support the development of medical institutions.

In order to allow more medical institutions to choose and respond to medical reform-related documents to support the development of social-run medical institutions when the insured seek medical treatment, the Municipal Human Resources and Social Security Bureau does not limit the main nature of medical institutions when agreeing on designated medical institutions for medical insurance, and eligible social-run medical institutions enjoy the same opportunities as public medical institutions to provide services for the insured. Social medical institutions that are included in designated medical insurance, like public medical institutions, implement a unified medical insurance management policy. As of August 20 16, there were 132' designated hospitals' in Shenzhen, including 68 hospitals run by the society, accounting for 5 1.5%.

In addition, Shenzhen changed the examination and approval system of designated medical institutions to the approval system, canceled the quantitative restrictions, and included all qualified medical institutions and retail pharmacies into designated medical insurance. By August, 2006, there were 2,264 institutions in Shenzhen. In order to support and encourage the development of more medical institutions and enjoy the right to provide services for the insured equally, the Municipal Human Resources and Social Security Bureau will start the revision of the management measures of the two institutions again in the near future, which will further standardize the application conditions of designated medical institutions and optimize the application procedures.

The difference between the first, second and third grades of Shenzhen medical insurance

Principle of seeking medical treatment

First-class insured: any designated medical institution in this city for medical treatment.

Second-class insured persons: outpatients seek medical treatment in the binding community health center, inpatient departments seek medical treatment in any designated medical institutions in the city, and outpatients seek medical treatment in designated medical institutions for serious illness.

Third-level insured persons: outpatients seek medical treatment in the binding social health center, and inpatients and outpatients seek medical treatment in prescribed medical institutions for serious illness.

General outpatient treatment

A type of insurance: personal account is used to pay the medical expenses within the scope of the insured's general outpatient medical insurance catalogue. Community health center basic medical expenses personal account to pay 70%, the overall fund to pay 30% in accordance with the provisions.

Second Insured/Third Insured:

Belong to class A drugs and class B drugs, respectively, by the community outpatient fund according to the proportion of 80% and 60% payment;

90% of the single diagnosis and treatment or medical materials belonging to the medical insurance catalogue shall be paid by the community outpatient co-ordination fund, but the maximum payment amount shall not exceed 120 yuan;

The total outpatient medical expenses paid by the community outpatient co-ordination fund to each second-grade and third-grade insured within a medical insurance year shall not exceed 1000 yuan.

Personal account family welfare

A class of insured persons: the accumulated amount of personal accounts exceeds 5% of the average salary of employees in this city in the previous year, and the excess can be purchased in designated pharmacies for over-the-counter drugs within the scope of medical insurance catalogue; When visiting a designated medical institution, you can pay the basic medical expenses and local supplementary medical expenses paid by yourself and your spouse and immediate family members who participate in the basic medical insurance in this Municipality; It can cover the health check-up and vaccination expenses for me, my spouse and immediate family members to participate in the basic medical insurance in this city.

Secondary Insured/Tertiary Insured: None.

Personal account is not enough to pay.

First-class insured person: First-class insured person has been insured continuously for one year, and the average salary of supermarket employees is 5% of the basic outpatient medical expenses and supplementary medical expenses paid by himself in the same medical insurance year, and 70% of the excess is paid by the overall fund according to regulations (80% for those over 70 years old).

Secondary Insured/Tertiary Insured: None.

Outpatient large-scale equipment inspection and treatment costs

First-class insured: 80% shall be paid by the overall fund as required.

Second-level insured/third-level insured: the highest unit price of general medical treatment items shall not exceed 120 yuan.

Blood transfusion cost in general outpatient department

First-class insured: 90% shall be paid by the overall fund as required.

Second-level insured/third-level insured: 70% shall be paid by the overall fund as required.

Treatment of serious illness in outpatient department

First-class insured/second-class insured/third-class insured: 60%-90% will be paid by the overall fund according to the continuous insurance years.

Medical examination subsidy

First-class insurance: one-time 500 yuan at retirement, 20 yuan per person per month (40 yuan per person over 70 years old).

Secondary Insured/Tertiary Insured: None.

be hospitalized

First-class insured: 95% or 90% of the basic medical expenses incurred in hospitalization and supplementary medical expenses above the deductible line shall be paid according to the regulations.

Second Insured/Third Insured:

1, you can be hospitalized in the settlement hospital of the binding social health center, or you can be referred to the prescribed hospital by the settlement hospital. The reimbursement ratio of basic medical expenses and local supplementary medical expenses above the hospitalization deductible line is:

Level I hospital: 85%

Level II hospital: 80%

Tertiary hospitals: 75%

2. If you go to a hospital other than the settlement hospital without referral, you will be paid 90% of the hospitalization payment standard of this hospital (that is, the payment standard in the above 1).

Seek medical treatment outside the city

First-class insured: general outpatient expenses, serious illness outpatient expenses and hospitalization expenses can be reimbursed according to regulations.

Second-class insured/third-class insured: general outpatient expenses will not be reimbursed; In accordance with the provisions of the serious illness outpatient expenses and hospitalization expenses can be reimbursed according to the provisions.

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