Scope of reimbursement of Shenzhen social security serious illness insurance

Legal analysis: 1. When the insured person is hospitalized, the accumulated self-paid part within the scope of the medical insurance catalogue exceeds 1 000 yuan, and 70% of the excess part is paid by the serious illness commercial insurance fund. If the patient Li suffers from a serious illness, he has to pay medical expenses of 6,543,800 yuan, of which 900,000 yuan is reimbursed for medical insurance, and the remaining 6,543,800 yuan is 90,000 yuan after deducting 6,543,800 yuan, and the critical illness insurance can be reimbursed for 63,000 yuan.

2. When the insured person suffers from serious illness and uses drugs in the self-funded drug list, 70% will be reimbursed by the serious illness commercial insurance fund, and the maximum payment in that year will not exceed 1.5 million yuan. In addition, the Social Security Bureau explained that in addition to the drugs in the medical insurance catalogue, seriously ill patients also need to use a large number of self-funded drugs. After purchasing critical illness insurance, the self-funded drugs in the self-funded drug list can be reimbursed in proportion. The scope of the self-funded drug list is jointly determined and published by Shenzhen social insurance institutions and serious illness commercial insurance contractors.

Legal basis: Article 23 of the Social Insurance Law of People's Republic of China (PRC), employees shall participate in the basic medical insurance for employees, and both employers and employees shall pay the basic medical insurance premium according to the provisions of the state.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.