Which major illnesses can be reimbursed twice, and is there a second reimbursement for serious illne

Legal analysis: only diseases that have been certified by the state can be reimbursed. 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 basis: Social Insurance Law of the People's Republic of China 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 protect citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc.

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.

The conditions for the second reimbursement of serious illness are as follows:

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, esophageal 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.

Insured persons who apply for the second reimbursement of serious illness medical insurance need to provide the following materials:

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].

Article 4 of the Social Insurance Law of the People's Republic of China 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 individual rights and interests records, 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.

Legal analysis: After the reimbursement of NCMS, the subsistence allowance can increase the reimbursement ratio, but it will not be reimbursed twice. NCMS secondary reimbursement is also known as NCMS critical illness insurance compensation:

Participating farmers do not need to pay a penny, and the critical illness insurance is allocated from the balance of NCMS funds at the rate of 15 yuan per person per year in that year.

Once a farmer commits a serious illness, he or she will be reimbursed for no less than 50% of the out-of-pocket expenses of more than 10,000 yuan on the basis of the reimbursement of NCMS.

The second reimbursement refers to the policy of secondary reimbursement for farmers suffering from serious illnesses and then after the reimbursement policy of NCMS and serious illness, the specific reimbursement standards are as follows: 55% reimbursement of 10,000-60,000 yuan; 60,000-100,000 yuan reimbursement of 60%; 100,000-150,000 yuan reimbursement 65%; 70% reimbursement for more than 150,000 yuan; The unified reimbursement rate for transfer to other hospitals** is 50%.

[Legal basis].

Regulations on the Minimum Subsistence Security for Urban Residents

Article 4: The minimum subsistence guarantee system for urban residents implements a system of responsibility for local people at all levels. The people's ** civil affairs departments at or above the county level are specifically responsible for the management of the minimum subsistence guarantee for urban residents within their respective administrative regions; The financial department shall implement the minimum subsistence guarantee fund for urban residents in accordance with regulations; Departments such as statistics, prices, auditing, labor and social security, and personnel are responsible for the division of labor, and are responsible for the work related to the minimum subsistence guarantee for urban residents within the scope of their respective duties. The people's civil affairs departments at the county level, as well as the neighborhood offices and town people's departments (hereinafter collectively referred to as the management and approval organs), are responsible for the specific management and approval of the minimum subsistence guarantee for urban residents.

Residents' committees may, on the basis of the entrustment of the management and examination and approval organs, undertake the daily management and service of the minimum subsistence guarantee for urban residents. The civil affairs departments are responsible for the management of the minimum subsistence guarantee for urban residents throughout the country.

Article 5: The funds needed for the minimum subsistence guarantee for urban residents are to be included in the fiscal budget by the local people**, and included in the special fund expenditure items for social relief, and are to be managed on a special basis and earmarked for special purposes. The State encourages social organizations and individuals to provide donations and subsidies for the minimum subsistence guarantee for urban residents; The donations and subsidies provided are all included in the minimum living security fund for local urban residents.

OK. NCMS Serious Illness Second Reimbursement Processing: 1. All compliant medical expenses are included in the compensation scope of NCMS Serious Illness Insurance.

Compliant medical expenses refer to the medical expenses incurred in the hospitalization of designated medical institutions in the unified areas of the New Rural Cooperative or referred to designated medical institutions in cities and provinces other than the unified areas, or the outpatient medical expenses for chronic diseases incurred in the designated medical institutions in the unified areas of the New Rural Cooperatives. 2. Among them, the proportion of classified expenses belonging to the catalogue of drugs and diagnosis and treatment items of the New Agricultural Cooperative shall be included in the liquidation scope according to 100, and the diagnosis and treatment expenses of material costs and other drug costs shall be included in the liquidation scope according to 30, except for the fixed payment according to the type of disease.

Social Insurance Law of the People's Republic of China

Article 24: The State is to 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 ***.

Article 25 The State shall establish and improve a 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 **.

Article 26 The standards for the treatment of basic medical insurance for workers, new rural cooperative medical care, and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 27 Individuals who participate in the basic medical insurance for employees and reach the statutory retirement age when the cumulative contributions reach the number of years prescribed by the state shall no longer pay the basic medical insurance premiums after retirement, and enjoy the basic medical insurance benefits in accordance with the provisions of the state; If the number of years prescribed by the state has not been reached, the fee can be paid until the number of years prescribed by the state.

Article 28 In line with the basic medical insurance drug list, diagnosis and treatment items, medical service facility standards and emergency and rescue medical expenses, in accordance with the provisions of the state from the basic medical insurance ** payment.

A second reimbursement is available for serious illness. The formal name of "secondary reimbursement" is actually "serious illness insurance system for urban and rural residents", which began to be piloted in 2012 and fully implemented in 2015, covering all insured persons of basic medical insurance for urban and rural residents. And from the original NCMS, it only compensates for 20 types of serious diseases, all.

Legal analysis: The second reimbursement for serious illness means that when a person is discharged from the hospital with a serious illness, in addition to the normal reimbursement at the time of discharge, he can also enjoy the second reimbursement. First of all, the hard condition is that people who have participated in the New Rural Cooperative Medical System or urban residents' medical insurance can enjoy it.

Legal basis: Social Insurance Law of the People's Republic of China 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 protect citizens' right to receive material assistance from the State and society in accordance with the law in the event of old age, illness, work-related injury, unemployment, childbirth, etc.

Hello, dear, there is a second reimbursement for hospitalization for serious illness. Lingshou shouts need to meet these conditions: 1. Only diseases that have been certified by the state can be reimbursed for the second time, 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 opportunistic infection, colon cancer, hemophilia, chronic myeloid leukemia, lung cancer, esophageal 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 based on the local ** regulations.

The insured person who applies for the second reimbursement of serious illness medical insurance needs to provide the following materials: 1. The original ID card or household registration booklet and the original certificate of participation; 2. Compensation settlement form of NCMS Qiye; 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.