What does critical illness insurance cover?

The risk of serious illness includes the following: congenital heart disease, leukemia, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, drug-resistant tuberculosis, opportunistic infection of AIDS and hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, 1 diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction, colon cancer, rectal cancer and so on. For the poor people who suffer from major diseases defined by rural medical insurance for serious illness and meet the rescue standards, the insurance reimbursement rate of medical insurance for serious illness is as high as 90%.

The medical insurance reimbursement method for hospitalization expenses is:

1. If you are hospitalized in a designated social security medical institution in the insured place, you can directly use medical insurance to reimburse and settle the payment. However, due to different regulations on the proportion of medical insurance reimbursement in different places, the specific amount of reimbursement depends on local regulations;

2. If you are hospitalized in different places, you need to apply for medical records in different places in advance, and you can record them in the "medical records in different places" applet or the medical insurance service center of the insured place. If you are hospitalized in a different place due to unexpected events, you need to call the hotline of the medical insurance service center in the insured place first, and then file the record after the other party agrees. After successful filing, hospitalization expenses incurred in designated social security medical institutions can be directly reimbursed and settled in the hospital. If you can't make reimbursement in the hospital, you can keep relevant information (such as hospitalization summary, medical expenses list, etc.) and go to the medical insurance service center for reimbursement after returning to the insured place.

Legal basis: Article 29 of the Regulations on Basic Medical Insurance for Urban Workers in People's Republic of China (PRC).

The hospitalization expenses for major diseases are paid in the following ways:

(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.

(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.

(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses.

The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.