Critical illness medical insurance secondary reimbursement standards

1. If the minimum payment standard is 0 to 20,000 yuan (including 20,000 yuan), the reimbursement ratio of serious illness medical insurance is 50%;

10,000 to 40,000 yuan (including 40,000 yuan), the reimbursement ratio of serious illness medical insurance is 60%;

10,000 to 60,000 yuan (including 60,000 yuan), the reimbursement ratio of serious illness medical insurance is 70%;

The reimbursement ratio of more than 10,000 yuan is 80%;

5. The specific indicators such as the reimbursement scope and proportion of the city's urban residents' medical insurance, and the starting line, will be adjusted year by year according to the local financing level, the growth level of medical expenses and the level of economic and social development, so as to reduce the burden of personal medical expenses to the greatest extent;

6. If the insured person needs to be transferred to another district, he or she shall go through the transfer procedures after the approval of the municipal medical insurance agency, and the reimbursement ratio of reasonable medical expenses beyond the starting line for serious illness shall be 50%.

Extended Materials. Basic medical insurance is a social insurance system established to compensate workers for economic losses caused by the risk of illness. Through the employer and individual payment, the establishment of medical insurance**, after the insured person is sick and incurs medical expenses, the medical insurance agency will give a certain amount of economic compensation, so as to avoid or reduce the economic risk caused by the illness of the worker.

Basic medical insurance is one of the most important types of insurance in the social insurance system, which together with basic endowment insurance, work-related injury insurance, unemployment insurance, maternity insurance, etc., constitute a modern social insurance system.

During the 13th Five-Year Plan period, China built the world's largest social security system, with basic medical insurance covering more than 1.3 billion people.

Origin of practice. In December 1998, the Decision on the Establishment of the Basic Medical Insurance System for Urban Employees (Guo Fa [1998] No. 44) was issued, requiring the establishment of a multi-level medical security system with the basic medical insurance system for urban employees as the core nationwide. The "Decision" points out that the main task of the reform of the medical insurance system is to establish a basic medical insurance system for urban workers, that is, to adapt to the socialist market economic system, and to establish a social medical insurance system to ensure the basic medical needs of workers and workers according to the ability of finance, enterprises, and individuals to bear it.

The principle of establishing a basic medical insurance system for urban workers is as follows: the level of basic medical insurance should be commensurate with the level of development of productive forces in the initial stage of socialism; All urban employers and their employees must participate in basic medical insurance and implement territorial management; The cost of basic medical insurance shall be borne by both the employer and the employee; Basic medical insurance** implements a combination of social pooling and personal accounts.

Contribution base. The payment base of basic medical insurance is that the employer takes the total salary of the employee stipulated by the state as the payment base, and the employee takes the salary income of the previous year as the payment base. If the wage income of employees is higher than 300% of the average salary of local employees, 300% of the average salary of local employees shall be used as the payment base.

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.

Answer: 50% or 60% of the minimum amount of the second reimbursement of rural medical insurance. The second reimbursement means that residents of urban residents' medical insurance or NCMS can apply for serious illness insurance again in addition to the normal reimbursement if they have high expenses for medical treatment last year, and there is no upper limit. Reimbursement Conditions:

After the reimbursement of basic medical insurance, urban residents within the scope of basic medical insurance policies pay more than the annual per capita disposable income of urban residents in the previous year, and rural residents within the scope of the basic medical insurance policy pay more than the annual per capita net income of rural residents in the previous year (hereinafter referred to as the "minimum amount"), included in the scope of urban and rural residents' serious illness insurance payment, for secondary reimbursement. Reimbursement amount: calculated in stages and paid in accumulation.

Expenses incurred in designated medical institutions of basic medical insurance above the minimum payment amount and within 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.

Answer: One can be reimbursed twice, not all serious illnesses can be reimbursed. For example, the state has included 20 diseases such as 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, and so on. In addition, it is also worth noting that it is not possible to reimburse if there is a cost, and the specific amount of money that needs to be reached to be reimbursed is determined by the local **, but under normal circumstances, it is more than 5,000 yuan, but due to the different development levels in various places, the starting line of reimbursement is not the same, and the specific reimbursement threshold needs to be subject to local ** regulations.

Hello answer. First of all, the proportion of reimbursement is different, the conditions and standards of insurance are also different, the procedures that need to be provided are different, and the way of handling is also different. The goal of critical illness medical insurance is to avoid catastrophic medical expenses for the family, so the reimbursement is split, and the higher the medical expenses, the higher the payment ratio.

If the minimum repayment amount is 0-20,000 yuan (including 20,000 yuan), the reimbursement ratio is 50%; If the minimum repayment amount is 200,000-40,000 yuan (including 40,000 yuan), the reimbursement ratio is 60%; If the minimum repayment amount is 40-60,000 yuan (including 60,000 yuan), the reimbursement ratio is 70%. Low-income families are covered by the Civil Affairs and Medical Insurance Bureau.

Hello. First of all, the proportion of reimbursement is different, the conditions and standards of insurance are also different, the procedures that need to be provided are different, and the way of handling is also different. The goal of critical illness medical insurance is to avoid catastrophic medical expenses for the family, so the reimbursement is split, and the higher the medical expenses, the higher the payment ratio.

If the minimum repayment amount is 0-20,000 yuan (including 20,000 yuan), the reimbursement ratio is 50%; If the minimum repayment amount is 200,000-40,000 yuan (including 40,000 yuan), the reimbursement ratio is 60%; If the minimum repayment amount is 40-60,000 yuan (including 60,000 yuan), the reimbursement ratio is 70%. Low-income families are covered by the Civil Affairs and Medical Insurance Bureau.

About 60%.

The proportion of secondary reimbursement for serious illness varies from region to region. Take Beijing as an example. 50% of the expenses incurred by the designated medical institutions of Beijing basic medical insurance above the "minimum payment amount" and within 50,000 yuan (inclusive) shall be reimbursed by the serious illness insurance funds; Expenses exceeding 50,000 yuan will be reimbursed by 60% of the critical illness insurance funds.

Legal basis: Article 1 of the "Guiding Opinions on Carrying out Serious Illness Insurance for Urban and Rural Residents" is an institutional arrangement for urban and rural residents to further protect the high medical expenses incurred by seriously ill patients on the basis of basic medical security, which can further amplify the effectiveness of protection, is the expansion and extension of the basic medical security system, and is a useful supplement to basic medical security. Carrying out this work is an urgent need to reduce the burden of medical expenses on the masses of the people for serious illnesses and to solve the problem of poverty caused by illness and return to poverty due to illness.

It is an intrinsic requirement for establishing and improving a multi-level medical security system and promoting the construction of a universal medical insurance system. It is an effective way to promote the interconnection and interaction of medical insurance, medical care and medicine, and promote the combination of leading and market mechanisms, and improve the level and quality of basic medical security. It is an important measure to further embody mutual assistance and promote social fairness and justice.

Legal Analysis: Reimbursement Standards: After the residents participating in the urban residents' medical insurance are reimbursed by the normal medical insurance, if the remaining part exceeds the per capita minimum payment amount of the city's urban residents in the previous year within the scope of medical insurance reimbursement, the excess part can be reimbursed.

If the excess part is less than 50,000 yuan, 50% can be reimbursed by critical illness, and 60% of medical expenses exceeding 50,000 yuan can be reimbursed by critical illness. At the same time, an uncapped reimbursement policy has also been implemented.

Legal basis: Article 29 of the Social Insurance Law of the People's Republic of China 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.

1. Requirements for the second reimbursement of serious illness medical insurance:

1. Only diseases that have passed the national certification can be reimbursed, such as 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, esophagus cancer, gastric cancer, and other 20 diseases are included in the scope of serious illness medical insurance;

2. It is not that there is a cost to be reimbursed, and the specific amount of money that needs to be reached to be reimbursed is determined by the local **, but under normal circumstances, it is more than 5,000 yuan, but due to the different development levels in various places, the starting line of reimbursement is not the same, and the specific reimbursement threshold needs to be subject to local ** regulations.

2. The insured persons who apply for the second reimbursement of serious illness medical insurance need to provide the following materials: Wu Lu Qiao.

1. The original ID card or household registration booklet and the original certificate of participation; 2. NCMS compensation statement;

3. A copy of the list of expenses, discharge summary or the official seal of the original receiving unit;

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

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

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

Legal basis

Social Insurance Law of the People's Republic of China

Article 4 Employers and individuals within the territory of the People's Republic of China who pay social insurance premiums in accordance with the law have the right to inquire about payment records and records of personal rights and interests, and to request social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits in accordance with the law, and have the right to supervise their own units' contributions for them.

Article 5: The people at or above the county level shall include social insurance undertakings in their national economic and social development plans. The state raises social insurance funds through multiple channels. The people at or above the county level shall give necessary financial support to the social insurance undertakings.

The state supports social insurance through preferential tax policies.

Minimum 10,000. The latest policy of the Social Security Bureau stipulates that serious illness insurance dates are sold.

The minimum reimbursement for the second time is 10,000. Due to the current basic medical insurance for urban and rural residents.

The actual reimbursement ratio of residents' inpatient medical expenses can reach more than 50%, and with the addition of serious illness insurance, the overall actual reimbursement ratio of serious illness medical expenses of urban and rural residents in the future can exceed 70%. Consult the Social Security Bureau of Dangchun Forest for details.

The reimbursement rate of the supplementary insurance for serious illness of employees is 70% of 55%. The reimbursement ratio for serious illnesses in urban residents' medical insurance and NCMS is between 50% and 80%.

The second reimbursement is that the employees of the enterprise participate in the employee medical insurance, and the urban residents stare at the sedan car to participate in the medical care of urban residents or the rural residents participate in the new rural cooperative medical care, if the medical expenses are high in the past year, in addition to the normal medical insurance reimbursement, you can also apply for serious illness insurance reimbursement in the school medical insurance department, no top line. Mainly for special diseases inpatient and hospital outpatient in designated medical institutions, ** within the scope of medical insurance catalog, except for personal medical expenses other than self-payment.

Cooperative medical expenses of supplementary insurance for employees' serious illness. The reimbursement ratio is determined according to the cost segment, and the cumulative compensation is implemented. The initial payment standard for reimbursement is tentatively set at 10,000 yuan, and there is no maximum payment limit.

The specific reimbursement ratio is 10,000 yuan to 60,000 yuan, including 60,000 yuan, and the reimbursement ratio is 55%; Medical expenses between 60,000 yuan and 100,000 yuan, including 100,000 yuan, 60% of the medical expenses will be reimbursed; If the medical expenses are between 100,000 yuan and 150,000 yuan, including 150,000 yuan, 65% of the medical expenses will be reimbursed; If the medical expenses exceed 150,000 yuan, 70% of the medical expenses will be reimbursed.

The starting line of the new rural cooperative medical insurance is 6,000 yuan, and the starting line of urban residents' medical insurance is 10,000 yuan. The main purpose of establishing critical illness insurance is to protect residents from catastrophic medical expenses. It brings heavy burdens and great pressure to the economic life and daily life of residents.

Therefore, critical illness insurance should be reimbursed in stages. The percentage of payment increases as the cost of medical treatment increases. The higher the medical bill, the higher the payout percentage.

The medical expenses are 00,000 yuan to 20,000 yuan. 50% reimbursement; Medical expenses of 20,000 yuan to 40,000 yuan will be reimbursed at 60%; 4-60,000 yuan of medical expenses will be reimbursed at 70%. If the medical expenses exceed 60,000 yuan, 80% will be reimbursed.

When setting specific financing standards for domestic medical insurance and the new rural cooperative medical system, the reimbursement scope and reimbursement ratio of the starting payment line. Different cities and regions will be adjusted according to the actual level of development and social development. The financing capacity and the growth level of medical expenses are adjusted year by year, with the aim of minimizing the burden of medical expenses on residents.