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Reimbursement policy of serious illness medical insurance

Legal analysis:

The scope of reimbursement for serious illness medical insurance:

1. Malignant tumor treatment: including chemotherapy (including endocrine-specific anti-tumor therapy), radiotherapy, isotope anti-tumor therapy, interventional anti-tumor therapy and traditional Chinese medicine anti-tumor therapy.

2, severe uremia outpatient hemodialysis peritoneal dialysis treatment.

3. Anti-rejection therapy after renal transplantation.

4. Treatment of severe mental illness: schizophrenia, depression (moderate or severe), mania, obsessive-compulsive disorder, mental retardation with mental disorder, epilepsy with mental disorder, paranoid psychosis. To participate in the basic medical insurance for residents, the medical expenses incurred in hospitalization (including outpatient specific diseases) shall be reimbursed by the basic medical insurance. Within the scope of the policy, if the annual accumulated personal burden exceeds the per capita disposable income of the residents of this Municipality in the previous year, the excess will be included in the coverage of serious illness insurance for urban and rural residents.

Legal basis:

"People's Republic of China (PRC) Social Insurance Law" Article 26 The treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.