What is the scope of medical insurance for serious illness?

China's critical illness insurance includes: binaural deafness, binocular blindness, paralysis, heart valve surgery, malignant tumor, acute myocardial infarction, apoplexy sequelae, major organ transplantation or hematopoietic stem cell transplantation, coronary artery bypass grafting, end-stage renal disease, multiple limb loss, acute or subacute severe hepatitis, benign brain tumor, deep coma, severe Alzheimer's disease, etc.

Legal objectivity:

Serious illness insurance is to reimburse the high medical expenses incurred by urban and rural residents due to serious illness. The purpose is to solve the problem of "poverty caused by illness and returning to poverty due to illness", so that most people will not fall into economic difficulties because of illness. 20 12 On August 30th, six ministries and commissions, including the National Development and Reform Commission, the Ministry of Health, the Ministry of Finance, Ministry of Human Resources and Social Security, the Ministry of Civil Affairs and the China Insurance Regulatory Commission, issued "Guiding Opinions on Developing Serious Illness Insurance for Urban and Rural Residents", which clearly aimed at the heavy burden of serious illness of urban residents' medical insurance and new rural cooperative medical insurance (NCMS) participants, introduced market mechanism, and established a serious illness insurance system to reduce the burden of serious illness for urban and rural residents. The reimbursement rate of medical insurance for serious illness shall not be less than. 20 12 On August 24th, the National Development and Reform Commission, the Ministry of Health, the Ministry of Finance, Ministry of Human Resources and Social Security, the Ministry of Civil Affairs and the China Insurance Regulatory Commission jointly issued the Guiding Opinions on Developing Serious Illness Insurance for Urban and Rural Residents. According to the Notice of the State Council on Printing and Distributing the Planning and Implementation Plan for Deepening the Reform of the Medical and Health System during the Twelfth Five-Year Plan (Guo Fa [20 12] 1 1No.), in order to further improve the medical security system for urban and rural residents, strengthen the multi-level medical security system for urban and rural residents' serious illness insurance, and effectively improve the level of serious and serious diseases, with the consent of the State Council, urban and rural residents are now being carried out. With the initial establishment of the universal medical insurance system, people have a basic guarantee for seeing a doctor. However, due to the low level of China's basic medical insurance system, especially the basic medical insurance for urban residents (hereinafter referred to as urban residents' medical insurance) and the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system), the people still strongly reflect the burden of medical expenses for serious illness. Serious illness insurance for urban and rural residents is an institutional arrangement to further protect the high medical expenses incurred by seriously ill patients on the basis of basic medical security, which can further amplify the effectiveness of the security, is the expansion and extension of the basic medical security system, and is a useful supplement to the basic medical security. Carrying out this work is an urgent need to reduce the burden of medical expenses for serious illness of the people and solve the problems of poverty caused by illness and returning to poverty due to illness; It is an inherent requirement to establish and improve a multi-level medical security system and promote the construction of a universal medical insurance system; It is an effective way to promote the interaction between medical insurance, medical care and medicine, promote the combination of government-led and market-oriented mechanisms, and improve the level and quality of basic medical security; It is an important measure to further embody the spirit of mutual assistance and promote social fairness and justice. Further improve the medical security system for urban and rural residents, improve the multi-level medical security system, and effectively improve the level of protection for serious and serious diseases. Basic principles of medical insurance for serious illness: (1) Adhere to people-oriented and make overall arrangements. Give priority to protecting people's health rights and interests, and effectively solve the outstanding problems of people's poverty caused by illness and returning to poverty due to illness. Give full play to the synergy and complementarity of basic medical insurance, serious illness insurance and medical assistance for serious and serious diseases, strengthen the connection between systems, and form a joint force. (2) Adhere to the government-led and professional operation. The government is responsible for basic policy formulation, organization and coordination, fund raising and management, and strengthening supervision and guidance. Make use of the professional advantages of commercial insurance institutions, support commercial insurance institutions to undertake serious illness insurance, give play to the role of market mechanism, and improve the operation efficiency, service level and quality of serious illness insurance. (3) Adhere to shared responsibility and sustainable development. The level of serious illness insurance should be related to economic and social development and medical consumption. The level and affordability of serious illness insurance for urban and rural residents should be adapted. Strengthen the awareness and role of social mutual assistance, and form a mechanism for the government, individuals and insurance institutions to share the risk of serious illness. Strengthen the principle of balance of payments in the current year, make reasonable calculations, start steadily, standardize operations, ensure the safety of funds and realize sustainable development. (four) adhere to local conditions, mechanism innovation. All provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps, under the principles determined by the state, formulate specific plans for carrying out serious illness insurance in light of local conditions. Encourage local governments to constantly explore and innovate, improve the access, withdrawal and supervision system of serious illness insurance, improve the payment system, guide rational diagnosis and treatment, and establish a long-term and stable operation mechanism of serious illness insurance.