Which critical diseases are reimbursed for the second time, and which ones need to be reimbursed for

The critical illnesses that can be reimbursed for a second time are as follows:

1. Only diseases that have passed the national certification can be reimbursed;

2. For example, the state has included 20 kinds of diseases, including childhood leukemia, congenital heart disease, end-stage renal disease, cleft lip and palate, breast cancer, cervical cancer, severe mental illness, drug-resistant tuberculosis, AIDS infection, colon cancer, hemophilia, chronic myeloid leukemia, lung cancer, esophageal cancer, gastric cancer, etc.

Legal basisArticle 28 of the Social Insurance Law of the People's Republic of China.

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards, and emergency and rescue medical expenses shall be paid from the basic medical insurance in accordance with national regulations.

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.

What is the secondary reimbursement process for serious illness.

1. The recipient of assistance shall submit a written application to the village (resident) committee where the household registration is located;

2. After receiving the application, the village (resident) committee shall investigate and verify the authenticity of the application materials submitted by the applicant and the applicant's family income, and submit the investigation and verification opinions to the village (resident) representative meeting for democratic evaluation;

3. After the democratic appraisal of the village (resident) representative meeting, the village (resident) representative meeting shall put forward democratic evaluation opinions, and the qualified applicants shall be publicized in the open column of village (resident) affairs, and the publicity period shall not be less than 3 days;

4. If there is no objection to the publicity, the village (resident) committee shall put forward the preliminary review opinions, and submit other materials to the township (town) people's ** and sub-district offices for review;

5. The township (town) people's ** and sub-district offices shall review the materials submitted by the village (resident) committee, and submit the audit opinions and other materials to the county (city, district) civil affairs department for examination and approval;

6. The county (city, district) civil affairs department shall review the materials submitted by the township (town) people and sub-district offices.

Standard: "Segmented calculation, cumulative payment". Expenses incurred in the designated medical institutions of basic medical insurance in Beijing with a "minimum payment amount" of more than 50,000 yuan (inclusive) shall be reimbursed by 50% of the serious illness insurance funds; Expenses exceeding 50,000 yuan will be reimbursed by 60% of the critical illness insurance funds.

According to the Municipal Medical Reform Office, in recent years, the basic medical insurance treatment of urban and rural residents in the city has been significantly improved, and the per capita financing standard has increased from 180 yuan in 2008 to 680 yuan in 2012, but it is undeniable that there are still some people who have major diseases and catastrophic medical expenses, and fall into the predicament of poverty due to illness and return to poverty due to illness, and even some people have to give up.

Serious illness insurance for urban and rural residents is a supplement to the current medical insurance, and an institutional arrangement to further protect the high medical expenses and catastrophic expenses incurred by the masses due to major diseases. In order to minimize the occurrence of poverty due to illness and return to poverty due to illness, the city decided that this new policy does not have a cap line, so that patients with serious illnesses can receive as much compensation as possible and reduce the burden on individuals and families.

1. If the starting payment line is 0 20,000 yuan (including 20,000 yuan), the reimbursement ratio is 50%; 2 40,000 yuan (including 40,000 yuan), the reimbursement ratio is 60%; 4 60,000 yuan (including 60,000 yuan), the reimbursement ratio is 70%; If the amount is more than 60,000 yuan, the reimbursement ratio will reach 80%.

2. The actual payment ratio of urban residents' medical insurance and NCMS serious illness insurance within one year shall not be less than 53%, and the specific indicators such as the specific financing standards, the starting payment line, and the reimbursement scope and proportion of segmented models will be adjusted year by year according to the level of economic and social development, the level of financing and the growth level of medical expenses, so as to reduce the burden of personal medical expenses to the greatest extent.

3. The insured persons who apply for the reimbursement of critical illness insurance shall provide the following materials:

1. Original ID card or household registration booklet;

2. Original participation card (card);

3. NCMS compensation settlement statement;

4. A list of expenses, or a copy of the official seal of the original receiving unit;

5. Discharge summary, or a copy of the official seal of the original storage unit;

6. Patients with special chronic diseases should provide chronic disease certificates, or special chronic disease diagnosis certificates issued by medical institutions above the second level, and Zhiying outpatient medical records;

7. Invoice for medical institution expenses, or a copy of the official seal of the original collection unit;

8. The bank remittance account of the patient himself or a related person who can provide proof of relationship with the patient.

Article 24 of the Social Insurance Law of the People's Republic of China provides that the State shall establish and improve a new type of rural cooperative medical system.

The management measures for the new type of rural cooperative medical care shall be stipulated by ***.

Legal analysis: It belongs to the category of outpatient special diseases under the residents' medical insurance, and the outpatient special disease procedures can be directly handled in the hospital, and the subsequent payment standards can be increased to reduce the burden on the patient's family. At the same time, within a year, after the reimbursement of the basic medical insurance, the medical expenses of more than 20,000 yuan and less than 300,000 yuan borne by the individual within the scope of the policy shall be included in the payment scope of the resident serious illness insurance and will be repaid according to the corresponding reimbursement ratio.

Residents' basic medical insurance and serious illness insurance implement a "one-stop" settlement, whether it is in the hospital network card settlement, or advance payment of medical expenses, the medical insurance system directly pays the reimbursement amount, and patients do not need to go through other related procedures.

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

Article 1: This Law is formulated on the basis of the Constitution so as to regulate social insurance relations, to preserve citizens' lawful rights and interests in participating in social insurance and to enjoy social insurance benefits, to enable citizens to share the fruits of development, and to promote social harmony and stability.

Article 2: The State shall establish social insurance systems such as endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to protect citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.

Legal analysis: It belongs to the category of outpatient special diseases of resident medical insurance, and the outpatient special disease procedures can be directly handled in the hospital, and the payment standard can be increased in the follow-up to reduce the burden on the patient's family. At the same time, within a year, after the reimbursement of the basic medical insurance, the medical expenses of more than 20,000 yuan and less than 300,000 yuan borne by the individual within the scope of the policy shall be included in the payment scope of the resident serious illness insurance and will be repaid according to the corresponding reimbursement ratio.

Residents' basic medical insurance and critical illness insurance implement a "one-stop" settlement, whether it is swiping a card in the hospital network to settle or pay medical expenses in advance, the medical insurance system of the property bank directly pays the reimbursement amount, and patients do not need to go through other relevant procedures.

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

Article 1: This Law is formulated on the basis of the Constitution so as to regulate social insurance relations, to preserve the lawful rights and interests of citizens to participate in social insurance and enjoy social insurance benefits, to enable citizens to share the fruits of development, and to promote social harmony and stability.

Article 2: The State shall establish social insurance systems such as basic endowment insurance, basic medical insurance, work-related injury insurance, unemployment insurance, and maternity insurance, to ensure citizens' right to receive material assistance from the State and society in accordance with law in the event of old age, illness, work-related injury, unemployment, childbirth, and so forth.