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Legal Analysis: The policy of the recipients and standards of serious illness assistance is:
1) All rural residents who participate in the city's new rural cooperative medical care and newborns who enjoy the medical treatment of the new rural cooperative medical treatment with their parents who meet one of the following three conditions shall be included in the scope of rural medical assistance for serious diseases:
1.Rural residents who are the first or mainly diagnosed with childhood leukemia (0-14 years old), childhood congenital heart disease (0-14 years old), end-stage renal disease, breast cancer, cervical cancer, severe mental illness, multidrug-resistant tuberculosis, and AIDS opportunistic infection;
22 types of major diseases, such as lung cancer, esophageal cancer, gastric cancer, colon cancer, rectal cancer, chronic myeloid leukemia, acute myocardial infarction, cerebral infarction, hemophilia, diabetes, hyperthyroidism, cleft lip and palate, BH4 deficiency, critical maternal and other 22 types of major diseases, hospitalization and outpatient medical expenses for serious illnesses;
After reimbursement by NCMS, the part of the annual self-borne expenses (natural year, the same below) of more than 3,000 yuan (including 3,000 yuan) within the scope of the NCMS reimbursement policy and the part of the annual self-borne expenses (natural year, the same below) of more than 3,000 yuan (including 3,000 yuan) outside the scope of the policy.
2.In addition to the above-mentioned 22 types of major diseases, the inpatient and outpatient medical expenses of the participating rural residents in the current year shall be reimbursed by the NCMS;
The part of the annual cumulative personal expenses within the scope of the NCMS reimbursement policy is more than 20,000 yuan (including 20,000 yuan) and the part of the annual cumulative personal expenses outside the scope of the policy is more than 40,000 yuan (including 40,000 yuan).
3.The upper limit of the proportion of expenses outside the scope of the NCMS reimbursement policy in the total medical expenses is 10% (including 10%, the same below) for the first-level NCMS designated medical institutions and 20% for the second-level NCMS designated medical institutions;
30% of the designated medical institutions of the NCMS at the municipal level and outside the city will not be provided, and the expenses outside the scope above the upper limit will not be assisted.
Legal basis
Social Insurance Law of the People's Republic of China
Article 6 The State shall exercise strict supervision over social insurance. and the people of provinces, autonomous regions and municipalities directly under the Central Government to establish and improve the supervision and management system of social insurance to ensure the safe and effective operation of social insurance. The people at or above the county level should take measures to encourage and support all sectors of society to participate in the supervision of social insurance.
Article 7 The social insurance administrative department shall be responsible for the social insurance administration of the whole country, and other relevant departments shall be responsible for the relevant social insurance work within the scope of their respective duties. The local people's social insurance administrative departments at or above the county level are responsible for the social insurance management work in their respective administrative regions, and other relevant departments of the local people's social insurance at or above the county level are responsible for the relevant social insurance work within the scope of their respective duties.
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Legal Analysis: Serious illness medical assistance refers to urban and rural residents suffering from major illnesses and causing difficulties in medical and family life, who are given limited financial assistance and enjoy preferential medical policies; Assistance will be provided to groups with special difficulties (including urban subsistence allowance recipients, rural subsistence allowance recipients, rural five guarantee recipients, urban workers in extreme poverty and their family members), and subsidize them to participate in the system of medical care for urban residents, such as slippery insurance or new rural cooperative medical care.
Legal basis: "Opinions of the General Office on the Comprehensive Implementation of Serious Illness Insurance for Urban and Rural Residents" 1Adhere to the people-oriented and protect against serious diseases.
Establish and improve the critical illness insurance system, continuously improve the level of critical illness protection and service accessibility, strive to safeguard the health rights and interests of the people, and effectively prevent the people from becoming poor due to illness and returning to poverty due to illness. 2.Adhere to overall planning and coordination and policy linkage.
Strengthen the convergence of basic medical insurance, serious illness insurance, medical assistance, disease emergency assistance, commercial health insurance and charitable assistance, give play to synergies and complementarities, output abundant security momentum, and form a joint force for protection. 3.Adhere to the leading and professional undertaking.
While strengthening the responsibilities of policy formulation, organization and coordination, supervision and management, etc., we should adopt the method of commercial insurance institutions to undertake serious illness insurance, give full play to the role of the slag empty wax market mechanism and the professional advantages of commercial insurance institutions, and improve the operation efficiency, service level and quality of serious illness insurance. 4.Adhere to steady progress and continuous implementation.
The level of protection of critical illness insurance should be commensurate with economic and social development, medical consumption and social affordability. Strengthen social mutual assistance and form a mechanism for individuals, individuals and insurance institutions to share the risk of serious illness. Adhere to local conditions and standardized operation to achieve the steady operation and sustainable development of critical illness insurance.
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Hello, according to the relevant national policies, there are three main types of serious illness subsidy policies: one is the basic medical insurance serious illness subsidy, the other is the urban and rural residents serious illness insurance subsidy, and the third Zheng Jianmao is the serious illness relief subsidy. Basic Medical Insurance Serious Illness Subsidy:
Refers to the basic medical insurance of employees, urban and rural residents in the process of receiving the first burial, by the basic medical insurance to give subsidies. Subsidy for Critical Illness Insurance for Urban and Rural Residents: refers to the subsidy given by the Critical Illness Insurance for Urban and Rural Residents in the process of receiving ** for the insured persons participating in the Critical Illness Insurance for Urban and Rural Residents.
Critical illness relief subsidy: refers to the subsidy given by ** to the insured who is unable to bear the cost of serious illness due to financial difficulties. In addition, some social organizations and enterprises will also give subsidies for serious illnesses to help poor families tide over difficulties.
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