Provisions on Secondary Reimbursement of Medical Insurance for Major Diseases

How much is the second reimbursement for medical insurance for major diseases? How to handle the second reimbursement? According to the latest policy of the Social Security Bureau, the minimum second reimbursement for medical insurance for major diseases is 1.5 million. Below, I will explain in detail the second reimbursement standard and reimbursement process of medical insurance for major diseases, and follow the article to understand it. For the strategy of medical insurance reimbursement, I just sorted out the relevant contents, hoping to help you: how to use social security medical insurance? 1. Teach you how to apply for reimbursement!

Provisions on Secondary Reimbursement of Medical Insurance for Major Diseases

Medical insurance for serious illness is a supplementary insurance for basic medical insurance. The payment of the basic medical insurance fund is capped. With medical insurance for serious illness, the medical expenses above the top line of basic medical insurance can be solved. The following is the proportion and process of the second timely reimbursement of critical illness insurance.

First, the standard and proportion of secondary reimbursement for medical insurance for major diseases

In 20 17, the deductible line for urban residents' medical insurance is 1 10,000 yuan, and the deductible line for serious illness of the new rural cooperative medical system is 6,000 yuan. The goal of serious illness insurance is to avoid catastrophic family medical expenses for residents. Therefore, the installment reimbursement is implemented. The higher the medical expenses, the higher the payment ratio.

If the deductible is 0 ~ 20,000 yuan (including 20,000 yuan), the reimbursement ratio is 50%; 20,000 to 40,000 yuan (including 40,000 yuan), and the reimbursement ratio is 60%; 40,000 to 60,000 yuan (including 60,000 yuan), and the reimbursement ratio is 70%; If it exceeds 60,000 yuan, the reimbursement rate will reach 80%.

The actual payment ratio of urban residents' medical insurance and new rural integration within one year is not less than 53%. Specific indicators such as financing standard, deductible line, scope and proportion of segmented reimbursement will be adjusted year by year according to the level of economic and social development, financing level and growth level of medical expenses, so as to minimize the burden of personal medical expenses.

In addition, if it is necessary to transfer to other areas for treatment, according to the Administrative Measures for Going Abroad for Medical Treatment, if the municipal medical insurance agency approves and handles the transfer procedures, the proportion of reasonable medical expenses outside the critical illness deductible line will be unified to 50%.

Second, the second reimbursement process of serious illness medical insurance

Participating patients should first apply for reimbursement of the new rural cooperative medical system. After the reimbursement of the new rural cooperative medical system, if the hospitalization expenses exceed the deductible line, they should apply for reimbursement of serious illness insurance. Those who do not enjoy the basic medical insurance benefits of the new rural cooperative medical system shall not enjoy the reimbursement benefits of the serious illness insurance of the new rural cooperative medical system.

In accordance with the principle of necessity and simplicity, the insured shall provide the following materials when applying for reimbursement of serious illness insurance:

1. Original ID card or household registration book of insured residents;

2. Original certificate (card);

3. The new rural cooperative medical compensation statement;

4. A list of expenses, or a copy stamped with the official seal of the original payee;

5 discharge summary, or a copy of the official seal of the original storage unit;

6 patients with special chronic diseases provide chronic disease certificates, or special chronic disease diagnosis certificates and outpatient medical records issued by medical institutions above the second level;

7. Medical institution expense invoice, or a copy stamped with the official seal of the original storage unit;

8. The bank remittance account number of the patient himself or the related person who can provide proof of the relationship with the patient.

The above is the proportion and process of the second reimbursement of medical insurance for major diseases that I introduced to you, hoping to help those in need.

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20 17 Proportion and scope of reimbursement for social security and serious illness medical insurance

It is not surprising that people are ill in hospital. People who have purchased medical insurance for serious illness can get certain reimbursement when they are hospitalized. However, many people are not very clear about the proportion and scope of reimbursement for serious illness medical insurance. In this regard, I would like to introduce the proportion and scope of reimbursement of serious illness medical insurance in 20 17 social security for your reference.

Shandong people must know the contents of the new policy of medical insurance for serious illness in Shandong on 20 17.

Serious illness medical insurance, that is, serious illness insurance for urban and rural residents, is to reimburse the high medical expenses incurred by urban and rural residents due to serious illness, with the aim of solving the problem of "poverty caused by illness and returning to poverty due to illness" strongly reflected by the masses, so that most people will no longer fall into economic difficulties due to illness. Introduce the new policy of 20 17 Shandong medical insurance for serious illness.