Reimbursement scope of mutual medical care for serious illness

Legal analysis: 1, as long as it meets the personal out-of-pocket expenses within the scope of reimbursement of basic medical insurance.

2, the basic medical insurance fund to pay more than the maximum amount and need to meet the basic medical insurance reimbursement scope. The hospitalization expenses of heart transplantation, liver transplantation and other diseases will be included in the scope of supplementary insurance for serious illness medical assistance.

Reimbursement ratio: 80% of the average salary of employees in the city in the previous year is the payment base, and the insured person is insured at the payment rate of 1%:

1, 1 10,000 yuan or less (including 1 10,000 yuan), and the remaining payment ratio is 77%; 2.1-30,000 yuan (including 30,000 yuan) and the rest is 80%; 3, the remaining 30-50 thousand yuan (including 50 thousand yuan) is 85%; 4. The remaining 90% shall be paid above 50,000 yuan.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; 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.

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.

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

(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.

Thirty-first social insurance agencies may, according to the needs of management services, sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior.

Medical institutions shall provide reasonable and necessary medical services for the insured.