Scope of reimbursement for serious illness of employee medical insurance

The scope of employee medical insurance reimbursement for serious illness mainly includes the following points:

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

2. Treatment of severe mental illness: schizophrenia, epilepsy with mental disorder, obsessive-compulsive disorder, mania, mental retardation with mental disorder, paranoid psychosis, depression (moderate or severe);

3, severe uremia outpatient hemodialysis, peritoneal dialysis treatment;

4. Anti-rejection therapy after renal transplantation.

Conditions for applying for medical assistance for serious illness:

1, rural five guarantees;

2, the town has no ability to work, no source of economic income, unable to support (support) people's supporters;

3. Minimum living guarantee for urban and rural residents;

4. Streamlined retired workers in the 1960s who enjoyed regular quantitative living allowances from civil affairs departments;

5, enjoy the key entitled groups of the civil affairs department regular pension subsidies;

6. Poor workers approved by the Federation of Trade Unions;

7. Urban and rural low income family members.

To sum up, the basic medical insurance for employees and serious illness medical insurance belong to the same medical insurance system (employee medical insurance), but belong to two different levels of medical insurance. Serious illness insurance is a kind of supplementary insurance for employees' medical insurance, and it is a kind of social medical mutual assistance based on employees' medical insurance system, which can meet the needs of employees' medical reimbursement for serious illness.

Legal basis:

Article 30 of People's Republic of China (PRC) Social Insurance Law

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.