What is the use of critical illness insurance in the five risks?

Major illness insurance in the Five Risks is an insurance system for major disease risks, which has the functions of reducing economic burden, improving medical security level and promoting rational utilization of medical resources.

Critical illness insurance, as an important part of the five insurances, is of great significance for ensuring people's health and stable life.

First, the basic concept and scope of protection of serious illness insurance

Serious illness insurance is an important part of the social insurance system, which aims to provide the insured with protection against serious illness. Its coverage usually includes major surgery or treatment projects such as malignant tumor, serious cardiovascular and cerebrovascular diseases and organ transplantation. When the insured is diagnosed with the above diseases, critical illness insurance will reimburse or subsidize the corresponding medical expenses.

Second, the role and significance of serious illness insurance

Serious illness insurance plays an important role in the social security system. First of all, it can effectively reduce the economic burden of the insured and their families and avoid getting into trouble due to high medical expenses. Secondly, serious illness insurance helps to improve people's medical security level and promote social fairness and stability. Finally, serious illness insurance can also promote the rational use of medical resources and promote the optimization and upgrading of medical services.

Third, the enrollment and reimbursement process of serious illness insurance.

Insured people usually need to apply for five insurances in the unit or community, including critical illness insurance. When the insured is diagnosed as a disease within the scope of protection, it is necessary to prepare corresponding reimbursement materials in accordance with relevant regulations, such as diagnosis certificate and medical expense invoice. Then, the insured person can submit these materials to the unit or social security agency for reimbursement. Upon examination, eligible insured persons will receive corresponding reimbursement or subsidies for medical expenses.

Four, the convergence of serious illness insurance and other medical security systems

Serious illness insurance, basic medical insurance, medical assistance and other systems are interconnected and isomorphic to form a multi-level medical security system in China. These systems have both division of labor and cooperation, providing all-round medical security for the insured. By constantly optimizing and perfecting these systems, we can better meet the growing medical security needs of the people.

To sum up:

Major illness insurance in the Five Risks is an insurance system for major disease risks, which has the functions of reducing economic burden, improving medical security level and promoting rational utilization of medical resources. Insured persons can apply for reimbursement or subsidy of medical expenses in accordance with relevant regulations after unified insurance procedures are handled by units or communities. Serious illness insurance is connected with other medical security systems, and * * * has become a multi-level medical security system in China.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 27 provides that:

Individuals who participate in the basic medical insurance for employees will not pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with the provisions of the state if they reach the statutory retirement age and the accumulated payment has reached the fixed number of years stipulated by the state; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.

People's Republic of China (PRC) social insurance law

Article 28 provides that:

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

People's Republic of China (PRC) social insurance law

Article 29 provides that:

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.