What is the significance of large medical insurance in social security?

Large medical insurance refers to the medical expenses that the insured exceeds the maximum payment limit of the basic medical insurance pooling fund due to serious illness or serious illness. On the basis of basic medical insurance, municipal medical insurance has established a large-scale medical insurance system.

Large medical insurance can be used to pay medical expenses in basic medical insurance coverage. Large medical insurance is based on people's participation in basic medical insurance. Enterprises pay large medical insurance premiums according to 1% of the payment base of employees and retirees in their own units, and the monthly payment of large medical insurance varies from region to region. People who participate in the basic medical insurance for urban workers can enjoy large medical insurance benefits after paying large medical insurance premiums according to regulations.

The maximum payment limit of the large-scale medical mutual aid fund for urban employees in hospital is 200 thousand yuan.

To participate in the basic medical insurance for urban workers, the reimbursement ratio of medical expenses incurred in hospitalization (including outpatient special diseases) exceeding the maximum payment limit of the basic medical insurance co-ordination fund and lower than the maximum payment limit of the large medical mutual fund shall be adjusted to 85% for on-the-job workers and 90% for retirees (including the unified supplementary medical insurance for retirees and 80% for the large medical mutual fund for hospitalization).

On-the-job employees seek medical treatment in community health service institutions in this Municipality, and the reimbursement rate of outpatient large-scale medical mutual fund is 90%; For medical treatment in other designated medical institutions other than community health service institutions in this Municipality, the reimbursement ratio of large outpatient medical mutual aid fund is 70%.

Retirees under the age of 70 seek medical treatment in community health service institutions in this city, and the reimbursement rate of outpatient medical expenses is 90% (including unified supplementary medical insurance for retirees, of which the reimbursement rate of large-scale outpatient medical mutual fund is 80%).

Serious illness insurance for urban and rural residents.

Serious illness insurance mainly serves urban and rural residents who participate in the basic medical insurance for urban residents in Beijing and the new rural cooperative medical system.

The expenses incurred by urban and rural residents in the designated medical institutions of basic medical insurance that meet the reimbursement scope of basic medical insurance for urban and rural residents in this Municipality, after being reimbursed by basic medical insurance, the high expenses paid by urban residents within the scope of basic medical insurance policy exceed the annual per capita disposable income of urban residents in the previous year, and the high expenses paid by rural residents within the scope of basic medical insurance policy exceed the annual per capita net income of rural residents in the previous year, which are included in the payment scope of serious illness insurance for urban and rural residents.

Legal basis:

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

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

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, 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.