What does medical insurance pay for serious illness insurance?

Legal analysis: First, the coverage of employee medical serious illness insurance.

Serious illness medical insurance is a special medical insurance fund set up to protect the medical needs of urban workers for major diseases, which is used to pay the medical expenses (excluding out-of-pocket expenses) that the insured who participated in the basic medical insurance for urban workers exceeded the maximum payment limit of basic medical insurance (40,000 yuan) during the year. Every insured person who participates in the basic medical insurance pays the medical insurance premium for serious illness to the municipal and district social insurance bureaus every year in 48 yuan. Medical expenses exceeding the maximum payment limit of the basic medical pooling fund shall be reimbursed by the social security department for 85% below RMB 0-40,000, 90% below RMB 40,000-80,000 and 95% above RMB 80,000. The maximum payment limit for each medical year is 6.5438 yuan +0.5 million yuan.

Legal basis: Regulations of People's Republic of China (PRC) Municipality on Basic Medical Insurance for Urban Workers.

Article 7 The basic medical insurance premium shall be paid jointly by the employer and the employees. Among them, the employer pays 5%-7% of the total monthly salary of its employees, and the rate of employees paying basic medical insurance premium is not less than 2% of their total monthly salary.

Article 8 The amount of employees' monthly wages is determined according to their actual total wages, but it shall not be less than 60% of the average monthly wages of employees in the city, county and autonomous county where they are located. The following medical insurance premiums that should be paid by themselves shall be paid by the employer.