What is the reimbursement ratio of critical illness medical insurance, and what is the reimbursement

Critical illness insurance provides protection for eligible medical expenses that need to be borne by individuals after the compensation of urban residents' medical insurance and NCMS. The actual payment ratio is not less than 50%, and the actual reimbursement ratio can be as high as 95%, but the policies vary from place to place. The settlement is automatically reviewed and handled by the medical insurance department through the data system.

Medical insurance is divided into employee medical insurance and urban and rural residents' medical insurance, and the reimbursement ratio varies from place to place. Take Beijing employee medical insurance as an example: the maximum limit is 20,000 yuan.

In-service employees can be reimbursed for outpatient and emergency medical expenses of more than 1,800, with a reimbursement ratio of 50%; Retirees can be reimbursed for outpatient and emergency medical expenses of more than 1,300 yuan, 70% for those under 70 years old, and 80% for those over 70 years old.

Critical illness medical subsidy treatment standard: After the accumulation exceeds the annual limit, the basic medical expenses incurred for specific inpatient and outpatient items shall be reimbursed by the critical illness medical subsidy at a rate of 95%, and the basic medical expenses of designated chronic disease outpatient clinics shall be reimbursed by the critical illness medical subsidy according to the corresponding standards, with a maximum payment limit of 150,000 yuan.

Reimbursement standard of supplementary medical insurance: under the maximum limit, the part paid by the individual, the cumulative part of more than 2,000 yuan will be reimbursed by the supplementary medical insurance 70%. Snail insurance.

Medical insurance is mainly divided into employee medical insurance and urban and rural residents' medical insurance, and the reimbursement ratio varies from place to place. Employee health insurance: Reimbursement rates vary for active employees, retirees under the age of 70, and retirees over the age of 70.

As for the medical insurance for urban and rural residents, the starting line and reimbursement ratio are different in different places. You can log on to the official website of the local human resources and social security bureau for inquiries.

Hello, may I ask, if the reimbursement ratio for outpatient services is 85 per hundred, what is the reimbursement ratio for hospitalization if you have a serious illness.

1. Generally speaking, the reimbursement ratio for serious illness medical treatment is:

The medical expenses of one-time hospitalization of employees who are sick or injured non-work-related or the part that exceeds 2,000 yuan within 30 days belong to the overall payment scope of the serious illness medical insurance for employees

90% of the part above 5,000 yuan will be paid.

85% of the part between yuan and 10,000 yuan and less than 10,000 yuan;

80% of the part between 10,000 yuan and 30,000 yuan and less than 30,00

85% of the part between 10,000 yuan and 50,000 yuan shall be paid;

90% of the portion above 10,000 yuan will be paid.

2. Insured persons participating in basic medical insurance, in the event of medical expenses exceeding the maximum payment limit of basic medical care, shall be reported by the social insurance department

85% reimbursement for less than 40,000 yuan;

90% reimbursement for less than 10,000 yuan - 80,000 yuan;

95% reimbursement for more than 10,000 yuan. The maximum payment limit is RMB 150,000 per medical year.

Article 26 of the Social Insurance Law stipulates that the treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations.

The reimbursement ratio of medical insurance for serious illness is: 55% of the part of the cumulative amount between 120,000 yuan and 30,000 yuan; Between 30,000 yuan and less than 100,000 yuan, 65% of the compensation will be paid; 75% of the compensation for the part above 100,000 yuan will be paid, and the maximum annual payment limit shall not be less than 300,000 yuan in principle. When calculating the cumulative amount of personal contribution of critical illness insurance, the amount of medical assistance enjoyed by poor patients in the current year is not deducted.

Implement effective protection and targeted assistance for difficult groups such as patients whose personal burden is still too heavy after being reimbursed by basic medical insurance and paid by serious illness insurance, targeted poverty alleviation targets, and poor people who have no money to abandon medical care. 75% of the personal burden within the scope of the basic medical insurance reimbursement of the insured persons of the serious illness medical insurance will be reimbursed by the supplementary insurance for mutual medical assistance for serious illness. Critical illness medical insurance reimbursement can be based on the cumulative amount, to get different degrees of serious illness medical insurance reimbursement ratio, and serious illness medical insurance can be reimbursed for breast cancer and other diseases, but not for traffic injury reimbursement, which shows the limitations of the use of critical illness medical insurance.

Legal basis: Article 26 of the Social Insurance Law of the People's Republic of China The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with national regulations.

The reimbursement ratio of serious illness medical treatment is: the medical expenses of one-time hospitalization of employees who are sick or not injured due to work-related injuries or the part that exceeds 2,000 yuan in total within 30 days belong to the overall payment scope of the serious illness medical insurance for employees

90% of the part above 5,000 yuan will be paid.

85% of the part between yuan and 10,000 yuan and less than 10,000 yuan;

80% of the part between 10,000 yuan and 30,000 yuan and less than 30,00

Before China's serious illness medical insurance, the reimbursement scope included 44 diseases, they are:

chronic severe hepatitis, cirrhosis; Tuberculosis, psychiatric disease, post-cardiovascular and cerebrovascular stenting, myasthenia gravis, motor neuron disease, acral gangrene, avascular necrosis of the femoral head, onset (cutaneous) myositis, panniculitis, epilepsy, Parkinson's disease, multiple sclerosis, systemic lupus erythematosus, polyarteritis nodosa.

Behcet's disease, systemic sclerosis, hypercortisolism, primary hyperaldosteronism, rheumatoid arthritis (active), Henoch-Schonlein purpura and nephropathy, Thrombocytopenic purpura, Pituitary tumor, diabetes insipidus, Polycythemia vera, Essential thrombocythemia, Essential ** fibrosis, Chronic renal insufficiency, Chronic aplastic anemia, Hemolytic anemia, Dysplastic syndrome.

Idiopathic pulmonary fibrosis, bronchial asthma, bronchiectasis, nephrotic syndrome, chronic cardiac insufficiency, valve replacement anticoagulation**, diabetes mellitus with heart, kidney, ophthalmology, neuropathy; Hypertension complicated with heart, brain, kidney, and vascular complications; Sequelae of stroke, uremic dialysis**, malignant tumors, organ transplantation, leukemia.

What is the reimbursement ratio of medical insurance for critical illness?

The reimbursement ratio of serious illness medical insurance is different from place to place, and the following reimbursement ratio is for reference:

1. Reimbursement ratio of residents' serious illness medical insurance.

10,000 yuan or less: 50% reimbursement ratio;

10,000 yuan to 80,000 yuan (inclusive): reimbursement ratio 60%;

10,000 yuan to 150,000 yuan (inclusive): 70% reimbursement ratio;

More than 10,000 yuan: reimbursement ratio of 80%;

5. Payment limit: no more than 200,000 yuan in a settlement year.

2. Reimbursement ratio of medical insurance for serious illness of employees.

85% reimbursement for less than 10,000 yuan;

90% reimbursement for less than 10,000 yuan - 80,000 yuan;

95% of the reimbursement for more than 10,000 yuan.

4.The maximum payment limit is RMB150,000 per medical year.

What is the scope of non-reimbursement by critical illness medical insurance?

1.Seeking medical treatment in non-designated hospitals without approval (except for emergency rescue);

2.Suffering from occupational diseases, work-related injuries or work-related injuries**;

3.Injuries caused by traffic accidents;

4.Causing harm due to one's own violation of the law;

5.Food poisoning caused by a liability accident;

6.Caused by suicide;

7.Injuries caused by medical malpractice;

8.According to the provisions of the state and the city, the medical expenses shall be borne by themselves.

The reimbursement ratio of serious illness medical insurance, which depends on the specific condition, can generally be reported more than 50%.

SHIn's current medical insurance card is 90% reimbursement for serious illnesses, and 100% reimbursement if there is a major medical insurance.

The reimbursement ratio of medical insurance: Critical illness medical insurance is based on basic insurance, and the second reimbursement is generally not less than 85%.

The reimbursement scope of critical illness medical insurance is to pay for medical expenses that exceed the maximum payment limit of basic medical co-ordination**, which shall be compensated by the social insurance department according to: the cumulative amount is 1 20,000 yuan and the part below 30,000 yuan (inclusive).

55％；Between 30,000 yuan and 100,000 yuan (inclusive), the part will be compensated 65; The part above 100,000 yuan will pay 75, and the maximum annual payment limit shall not be less than 300,000 yuan in principle.

1. Reimbursement ratio of medical insurance for serious illness of employees.

Serious illness medical insurance for employees is a special medical insurance established to protect the medical needs of urban employees for major diseases, which is mainly used to pay for the medical expenses of the insured persons who participate in the basic medical insurance for urban employees and exceed the maximum payment limit of the basic medical insurance in a year.

The reimbursement ratio of serious illness medical insurance for employees can be mainly divided into the following three levels: 0 40,000 yuan below the reimbursement 85; 40,000 yuan, reimbursement of less than 80,000 yuan90; More than 80,000 yuan reimbursement reimbursement 95. The maximum payment limit is RMB150,000 per medical year.

How to increase the reimbursement ratio of employees' serious illness medical insurance?

For people who already have social basic medical insurance, when hospitalized for common diseases, the medical expenses reimbursed can basically reduce people's economic burden, but once they have a major illness, then part of the expenses reimbursed by social security medical care are insignificant in the face of high medical expenses, even if the employee serious illness medical insurance will reimburse the medical expenses according to a certain proportion, and the maximum reimbursement of about 150,000 yuan of critical illness subsidies, but for the operation costs of hundreds of thousands of dollars and the later stage, The cost of recuperation is far from sufficient. Therefore, we need to increase the reimbursement ratio of serious illness medical insurance for employees through commercial serious illness medical insurance.

Because commercial critical illness medical insurance is not a reimbursement type of insurance, it has the function of early payment, once the insured is diagnosed by a medical institution to suffer from a critical illness within the scope of disease protection, then the insured can rely on the diagnosis certificate to receive a one-time critical illness insurance benefit, without waiting for the end of **. In this way, while reducing the financial pressure on the insured's family, it can also ensure that the disease will not be delayed due to the shortage of expenses. Therefore, commercial serious illness medical insurance is actually a supplementary insurance to employees' serious illness medical insurance.

Legal analysis: 20 diseases included in the critical illness benefit: childhood leukemia, congenital heart disease, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, drug-resistant tuberculosis, AIDS** infection, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction and death, colon cancer, rectal cancer.

The coverage of sickness insurance should be linked to the medical insurance for urban residents and the New Rural Cooperative Medical System. Urban residents' medical insurance and NCMS shall provide basic medical security in accordance with policy provisions. On this basis, the critical illness insurance mainly protects the compliant medical expenses that need to be borne by the urban residents after the medical insurance and the NCMS compensation under the condition that the insured (combined) suffers from a serious illness and incurs high medical expenses.

For the purpose of high medical expenses, the annual cumulative compliant medical expenses borne by the individual may exceed the annual per capita disposable income of urban residents and the annual per capita net income of rural residents announced by the local statistics department in the previous year, and the specific amount shall be determined by the local government.

Legal basis: Social Insurance Law of the People's Republic of China

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and medical expenses, emergency and rescue medical expenses, in accordance with the provisions of the State from the basic medical insurance **.

Article 29 The part of the medical expenses of the insured persons that should be paid by the basic medical insurance** shall be directly settled by the social insurance agency and the medical institution and the drug business unit. The administrative department of social insurance and the administrative department of health shall establish a system for the settlement of medical expenses for medical treatment in other places to facilitate the insured persons to enjoy basic medical insurance benefits.