Jiangsu serious illness medical insurance reimbursement scope

Medical insurance coverage, a serious illness in Jiangsu, replied that the supplementary medical insurance for serious illness is a special medical insurance fund set up to protect the medical needs of urban workers for major diseases, and it is used to pay the medical expenses (excluding out-of-pocket expenses) that the insured persons have accumulated over the maximum payment limit (40,000 yuan) of the basic medical insurance for urban workers 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 objectivity:

Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, standards of medical service facilities and medical expenses for emergency rescue, and shall be paid from the basic medical insurance fund in accordance with state regulations.