How to reimburse for serious illness?

Legal analysis: serious illness co-ordination is a part of medical insurance, mainly a kind of social insurance. In order to better protect seriously ill patients, the Chinese government has launched serious illness coordination.

1, reimbursement scope of major illness insurance as a whole

Outpatient medical expenses incurred by the insured after handling the examination and approval procedures for special diseases due to radiotherapy and chemotherapy for malignant tumors, renal dialysis and taking anti-rejection drugs after renal transplantation.

2, serious illness insurance reimbursement process

The insured person submits the certificate to the unit or social security office, and the unit declares the certificate to the medical insurance center. The medical insurance center completed the audit, settlement and payment on the same day.

3, serious illness insurance reimbursement ratio as a whole

The reimbursement rate is the same as hospitalization. The settlement period of outpatient special diseases is 360 days.

4. Medical management of serious illness insurance

The insured can only choose one hospital as the designated hospital for special diseases. Please use the Beijing Medical Insurance Manual for medical treatment. If the unit pays the full amount, the individual only needs to pay the personal out-of-pocket expenses and the self-funded part, and the reimbursement amount of the overall fund is settled by the hospital and the district medical insurance center.

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

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.