How to handle the process with critical illness insurance

Serious illness medical insurance application materials.

1. Employee's "Medical Insurance Card" and "Serious Illness Medical Insurance Payment Card";

2. Approval form for the overall planning and payment of medical expenses for serious illness (three) (with official seal);

3. Discharge diagnosis certificate (emergency rescue diagnosis certificate should be issued for emergency rescue), settlement list of hospitalization medical expenses for patients with serious illness, special receipts for hospitalization charges and hospitalization fee settlement (hospitalization reimbursement voucher);

4. An approval form should be issued for special inspection, special ** or the use of valuable drugs.

5. Outpatients are required to provide a prescription for diagnosis, a prescription for serious illness and a special receipt for outpatient charges in Beijing.

6. The transfer certificate issued by the hospital's Serious Illness Coordination Office should be provided.

7. Other materials stipulated by the overall medical care for serious illnesses.

8. The time limit for reimbursement of documents shall be within 60 days based on the last day of discharge or outpatient treatment, and no reimbursement will be made after the deadline.

9. A one-time reimbursement system is implemented for serious illness medical expenses, and no reimbursement will be made up for any omission caused by enterprises, individuals and hospitals.

10. If the reimbursement materials are incomplete due to enterprises, individuals and hospitals, the payment will be suspended.

Procedure. All seriously ill patients, once hospitalized, must send the diagnosis certificate, their basic medical insurance diagnosis and treatment manual and other materials to the medical insurance department of the hospital where they live for registration and verification as soon as possible, so as not to affect the reimbursement of inpatient medical expenses.

To apply for outpatient reimbursement for 23 diseases such as liver cirrhosis, insured residents should take their basic medical insurance diagnosis and treatment manual and the materials required for the declaration of diseases to the medical insurance department of the specified designated hospital at the specified time (please refer to the local policy for specific conditions) to fill in the relevant ** for preliminary review.

The designated hospital will report the information of the qualified insured residents to the urban medical insurance agency for review.

Reimbursement Ratio Criteria.

The actual payment ratio of critical illness insurance shall not be less than 50%.

In terms of the protection content of serious illness insurance for urban and rural residents, the "Opinions" pointed out that the protection object of critical illness insurance is the insured (co-insurance) of urban residents' medical insurance and NCMS, and the scope of protection should be connected with urban residents' medical insurance and NCMS. 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 eligible medical expenses that need to be borne by the urban residents after the medical insurance and the NCMS compensation in the case of high medical expenses incurred by the insured (combined) person suffering from a serious illness.

In addition, the level of protection of critical illness insurance is aimed at avoiding catastrophic family medical expenses for urban and rural residents, and the compensation policy of critical illness insurance is reasonably determined, and the actual payment ratio is not less than 50%; In principle, the higher the medical expenses, the higher the payment ratio.

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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.

The process of handling critical illness insurance is as follows:

1. For declaration and registration, the policyholder should bring the original and copy of his ID card to the business hall of the insurance company, select the appropriate serious illness medical insurance product, and fill in the insurance purchase form;

2. Select the payment method, and the selected payment methods include one-time payment, annual payment and monthly payment;

3. Apply for or submit a current bank card for future premium payment or insurance payment;

4. Read and sign the insurance contract, and the policyholder should read the terms of the serious illness medical insurance contract in detail, and sign after confirming that there is no objection;

5. After signing the insurance contract, the insured needs to pay the first insurance premium, and if it is paid annually, the corresponding premium will be paid every year thereafter.

Serious illness insurance is to reimburse the high medical expenses incurred by urban and rural residents due to serious illness, with the purpose of solving the problem of poverty due to illness and returning to poverty due to illness, so that the vast majority of people will no longer fall into economic difficulties due to illness.

Legal analysis: Critical illness medical insurance needs to go to the social security service point in the local community street, or the social security bureau (labor and social security bureau) at the district and county level. Among them, the main handling methods are:

1. Individuals who pay serious illness medical insurance can go to social security (pension + medical care) as a freelancer.

2. Participation conditions: urban hukou or rural to non-hukou.

4. The basic information required in the issue of individual payment of medical insurance: household registration book, ID card and photocopy, 2 1-inch **.

Legal basis: "Opinions of the General Office on the Comprehensive Implementation of Serious Illness Insurance for Urban and Rural Residents" Article 2 Financing Mechanism for Critical Illness Insurance.

1) Scientifically calculate the financing standards. Taking into account factors such as the level of local economic and social development, the high medical expenses incurred by serious illnesses, the financing capacity and payment level of basic medical insurance, and the level of protection of critical illness insurance, all localities should scientifically and meticulously calculate the funds and reasonably determine the financing standards of serious illness insurance.

2) Stable funding**. A certain percentage or amount of basic medical insurance for urban and rural residents** will be set aside as funds for serious illness insurance. In areas where there is a surplus in the basic medical insurance for urban and rural residents, the surplus shall be used to raise funds for serious illness insurance; Areas with insufficient or no surplus shall be arranged in the annual fundraising**.

Improve the multi-channel financing mechanism for basic medical insurance for urban and rural residents to ensure the sustainable development of the system.

3) Improve the level of overall planning. In principle, the implementation of serious illness insurance at the municipal (prefecture) level is carried out, and the provincial level or the whole province (district, city) is encouraged to unify policies and organize the implementation to improve the ability to resist risks.

Legal analysis: Serious illness medical insurance: Serious illness medical co-ordination ** At the beginning of the year, a one-time payment will be made to the medical insurance center, and the medical insurance center will participate in the serious illness medical insurance of commercial insurance companies.

For the basic medical insurance co-ordination ** above the maximum payment limit, the maximum payment limit of serious illness medical insurance is less than 150,000 yuan, in line with the medical expenses stipulated in the basic medical insurance payment, the serious illness medical insurance pays 90%, and the employee bears 10%.

Legal basis: Article 25 of the Social Insurance Law of the People's Republic of China The State shall establish and improve the basic medical insurance system for urban residents. The basic medical insurance for urban residents implements a combination of individual payment and subsidy.

Those who enjoy the minimum living guarantee, the disabled who have lost the ability to work, the elderly over the age of 60 and minors from low-income families, etc., will be subsidized by **.