What diseases are covered by medical insurance critical illness, and what diseases are covered by cr

Critical illnesses covered by medical insurance include the following:

1. Childhood leukemia;

2. Congenital heart disease;

3. End-stage renal disease;

4. Breast cancer;

5. Cervical cancer;

6. Severe mental illness;

7. Drug-resistant tuberculosis;

8. AIDS chance infection;

9. Hemophilia;

10. Chronic myeloid leukemia;

11. Cleft lip and palate;

12. Lung cancer;

13. Esophageal cancer;

14. Gastric cancer;

15. Type I diabetes mellitus;

16. Hyperthyroidism;

17. Acute myocardial infarction;

18. Cerebral infarction;

19. Colon cancer;

20. Rectal cancer.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by the risk of disease. Through the employer and individual payment, the establishment of medical insurance**, after the insured person is sick and incurs medical expenses, the medical insurance institution will give him a certain amount of economic compensation.

The establishment and implementation of the basic medical insurance system gathers the economic strength of the unit and the members of the society, coupled with the first funding, which can enable the sick members of the society to obtain the necessary material help from the society, reduce the burden of medical expenses, and prevent the sick members of the society from "becoming poor due to illness".

Medical insurance, in the traditional sense, refers to the management of medical insurance by a specific organization or institution, through mandatory policies and regulations or voluntary contracts, in a certain area of a certain group of insured people**.

Medical insurance has the basic characteristics of social insurance, such as compulsory, mutual aid and sociality. Therefore, the medical insurance system is usually enforced by national legislation, and the establishment of a first-class system, the cost is jointly paid by the employer and the individual, and the medical insurance premium is paid by the medical insurance institution to solve the medical risk caused by the illness or injury of the worker.

Legal basis] Detailed Rules for the Implementation of the Social Insurance Law of the People's Republic of China

Eighth insured persons in the agreement of the medical expenses incurred in the medical institutions, in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, in accordance with the provisions of the State from the basic medical insurance **.

If the insured person really needs emergency treatment or rescue, he or she can seek medical treatment in a non-agreed medical institution; The scope of drugs that must be used for rescue purposes may be appropriately relaxed. The specific management measures for medical services for emergency and rescue of insured persons shall be formulated by the overall planning area according to the actual local situation.

Including: malignant tumors, acute myocardial infarction, sequelae of stroke, major organ transplantation or hematopoietic stem cell transplantation, coronary artery bypass grafting (or coronary artery bypass grafting), end-stage renal disease (or chronic renal failure uremia stage), multiple limb loss, benign brain tumor, chronic liver failure decompensation, encephalitis sequelae or meningitis sequelae, etc.

1. Malignant tumors.

Refers to the uncontrolled progressive growth and spread of malignant cells, infiltrating and destroying surrounding normal tissues, and can be menstrual blood. Diseases in which the tubes, lymphatic vessels, and body cavities spread to other parts of the body. The diagnosis is confirmed by pathological examination.

The clinical diagnosis falls under the category of malignancies under the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10).

2. Acute myocardial infarction.

Refers to partial myocardial necrosis caused by insufficient blood supply to the corresponding area due to coronary artery occlusion. At least three of the following conditions must be met:

1) Typical clinical manifestations, such as acute chest pain;

2) recent ECG changes suggestive of acute myocardial infarction;

3) diagnostically elevated cardiac enzymes or troponin, or dynamic changes consistent with acute myocardial infarction;

4) 90 days after the onset of the disease, the left ventricular function was confirmed to be reduced, such as the left ventricular ejection fraction was less than 50%.

3. Sequelae of stroke.

It refers to cerebral vascular hemorrhage, embolism or infarction caused by sudden lesions of cerebral blood vessels, and leads to permanent dysfunction of the nervous system. Permanent dysfunction of the nervous system, defined as one or more of the following disorders remaining 180 days after the diagnosis of the disease:

1) Complete loss of function of one or more limbs;

2) complete loss of language ability or ability to chew and swallow;

3) Complete loss of the ability to live independently, unable to perform three or more of the six basic activities of daily living independently.

4. Major organ transplantation or hematopoietic stem cell transplantation.

Major organ transplantation refers to an allogeneic transplant of the kidney, liver, heart or lungs due to organ failure.

5. Coronary artery bypass grafting (or coronary artery bypass grafting).

Refers to the most severe coronary heart disease, and the operation of coronary artery bypass grafting with thoracotomy was actually performed. Coronary artery stenting, cardiac catheterization balloon dilation, laser radiofrequency technology and other non-thoracotomy interventional procedures and laparoscopic surgeries are not covered.

Critical illness insurance includes severe and critical illness insurance, including severe and life-threatening, unguaranteed quality of life, inability to take care of oneself, poor disease prognosis, and serious shortening of life.

At present, there are about 20 kinds of diseases included in the critical illness insurance in China, including malignant tumors such as leukemia, pheochromocytoma, small cell liver cancer, and acute myocardial infarction, which refers to irreversible infarction of the heart caused by myocardial ischemia.

Hello! There are many critical illness insurance policies on the market, and the coverage may vary depending on the product.

However, no matter what the product is and how the protection changes, as long as it is critical illness insurance, it must include 28 types of critical illnesses that must be insured, which is a mandatory regulation of the CBIRC.

Things like malignant tumors, acute myocardial infarction, sequelae of stroke, benign brain tumors, etc. are included.

The 28 types of critical illness are as follows:

In the process of choosing critical illness insurance, we usually have a misunderstanding, that is, we think that the more critical illnesses covered by critical illness insurance, the better.

These critical illnesses have covered more than 95% of critical illness claims.

So we don't have to worry too much about how many critical illnesses are covered by critical illness insurance, and we can focus on other aspects of protection.

In addition to providing 28 types of critical illness protection, critical illness insurance also covers other aspects.

Generally, it also includes moderate illness protection and mild illness protection, of course, some critical illness insurance plans list these two benefits as optional liabilities, and consumers can choose flexibly.

Some critical illness insurance plans also provide a wealth of optional liabilities, such as multiple benefits for critical illnesses, multiple benefits for specific cardiovascular and cerebrovascular diseases, multiple benefits for cancer, and so on.

In addition to the benefits mentioned above, critical illness insurance may also include premium waiver for the insured person, death benefit, etc., depending on the product.

Therefore, through the above analysis, we know that the coverage of critical illness can be divided into a certain part and an uncertain part.

The definite part is the 28 types of critical illnesses that must be covered by the CBIRC's critical illness insurance, and no matter what critical illness insurance, these protections are available.

Then the uncertain part is the moderate illness benefit, mild illness benefit, death benefit, policyholder, insured waiver and other optional liabilities.

Different products, protection may also be different, when we apply for insurance, we should combine our own protection needs with the protection of the product to find a product that suits us.

Hope daddy's is helpful to you!

1. What diseases are covered by serious illness medical insurance? In order to reduce the economic burden of residents' illness, the state will include some major diseases in the scope of serious illness medical insurance, including 20 diseases included in the serious illness medical insurance: 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, colon cancer, rectal cancer.

2. What is the reimbursement ratio of medical insurance for serious illnessIn terms of reimbursement ratio, patients with serious illnesses who still need to bear reasonable medical expenses after being reimbursed by basic medical insurance will be reimbursed by more than 50%. In addition, the payment ratio for medical expenses is set by section, and in principle, the higher the medical expenses, the higher the payment ratio. The compensation base is the part of the personal responsibility exceeding 5,000 yuan.

The reimbursement ratio is incremented in stages. 50% of the compensation base from 0 to 10,000 yuan (including 10,000 yuan) will be reimbursed; 10,000 to 20,000 yuan (including 20,000 yuan) reimbursement 55%; 2 to 50,000 (including 50,000) reimbursement of 60%; 65% reimbursement for more than 50,000 yuan. Where urban and rural residents seek medical treatment in medical institutions below the municipal level, compensation shall be made in accordance with the proportion of 5% and 10% respectively increased by the prescribed reimbursement ratio at the municipal and county levels.

There is no cap on the reimbursement amount. In accordance with the method of "basic medical insurance, serious illness medical insurance, and medical assistance", the actual reimbursement ratio of hospitalization expenses for urban and rural residents will be continuously increased. The medical insurance for serious illnesses mainly includes childhood leukemia, hemophilia, lung cancer, diabetes and other diseases with heavy economic burden, and its reimbursement ratio changes according to the actual situation.

China's critical illness insurance includes: deafness in both ears, blindness in both eyes, paralysis and blindness, heart valve surgery, malignant tumors, acute myocardial infarction, sequelae of stroke, major organ transplantation or hematopoietic stem cell transplantation, coronary artery bypass grafting, end-stage renal disease, multiple limb loss, acute or subacute abrasive hepatitis, benign brain tumor, deep coma, severe Alzheimer's disease, etc.

Article 28 of the Social Insurance Law.

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. Cover key.

Major diseases include: malignant tumors, acute myocardial infarction, sequelae of stroke, major organ transplantation or hematopoietic stem cell transplantation, coronary artery bypass grafting (or coronary artery bypass grafting), end-stage renal disease (or chronic renal failure uremia stage), multiple limb loss, benign brain tumor, decompensated stage of chronic liver failure, sequelae of encephalitis or sequelae of meningitis, etc.

1. Malignant tumors - excluding some early-stage malignant tumors.

2. Acute myocardial infarction.

3. Sequelae of stroke - permanent dysfunction.

4. Major organ transplantation or hematopoietic stem cell transplantation - allogeneic transplantation.

5. Coronary artery bypass grafting (or coronary artery bypass grafting) - thoracotomy is required.