北京普惠健康保险都保什么

2025年04月08日 09:36
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普惠健康保是什么?


普惠健康保一般是指北京普惠健康保,是由银保监会北京监管局指导推出的,紧密衔接医保的一款普惠型补充医疗保险。该保险可报销医保内外医疗费用以及100种海内外高额特药,投保不限年龄、职业、户籍和健康状况,北京市医保参保在保人员均可参保。


主要有一下保障:


1、医保目录内住院+门急诊个人自付费用

保额为100万元/年。免赔额为承保期间当年的北京市大病医疗保险起付标准(以2020年为例:城镇职工3.95万,城乡居民3.04万),如北京市大病医疗保险起付标准政策调整,则医保内责任免赔额也相应调整。给付比例健康人群为80%,特定既往症人群为40%。

2、医保目录外住院个人自费费用

保额为100万元/年。免赔额为健康人群2万元,特定既往症人群4万元。给付比例为健康人群70%,特定既往症人群35%。单一药品每年赔付上限为30万元;单一植体或耗材,每年赔付上限为10万元。

3、百种海内外高额特药

25种国内特药保额为50万元/年,75种国外特药保额为50万元/年,合计保额100万元/年。国内特药免赔额为健康人群2万元,特定既往症人群4万元;国外特药免赔额为健康人群2万元,特定既往症人群4万元。给付比例为健康人群60%,特定既往症人群30%。

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