What is the top line of social security serious illness?

The maximum payment limit of social security is 450,000 yuan, of which the maximum payment limit of the basic medical insurance pooling fund is 200,000 yuan, the maximum payment limit of the serious illness medical mutual fund is 250,000 yuan, and the part that exceeds the maximum payment limit of the basic medical insurance pooling fund is 450,000 yuan.

1, the maximum reimbursement amount of medical insurance for urban workers: outpatient reimbursement, 20,000 yuan; Hospitalization reimbursement, 300,000 yuan;

2. The maximum reimbursement amount of medical insurance for urban residents: outpatient reimbursement: 2,000 yuan; Hospitalization reimbursement: 6.5438+0.7 million yuan.

There are two kinds of medical insurance, one is urban workers' medical insurance, and the other is urban and rural residents' medical insurance. Because of the regional differences in this medical insurance reimbursement, the regulations are different across the country. Let's take Beijing as an example. First of all, it should be pointed out that the upper limit of medical insurance reimbursement must be regular, and it is based on the year rather than the number of times. In the medical insurance for urban workers, according to the illness, there are two general expenses, one is reimbursement for outpatient treatment and the other is reimbursement for hospitalization. Let's take a look at the annual reimbursement of outpatient service.

According to the nature of insured users, employees are still retirees, and the rules here are different. Judging from the situation of retirees, because of their age and high probability of illness, they can get more preferential treatment than employees. The deductible line for retirees is 1300 yuan, and the share of expenses reimbursement is 85%.

Social security hospitalization reimbursement items:

1. Reimbursement scope: hospitalization expenses incurred by the insured in designated medical insurance hospitals or specialized hospitals, traditional Chinese medicine hospitals and tertiary hospitals selected by the individual;

2. Inpatient deductible line: the standard of the first hospitalization deductible line in a natural year is 1.300 yuan, and 650 yuan every time thereafter;

3. Reimbursement ratio: 90% in the first-class hospital, 87% in the second-class hospital and 85% in the third-class hospital, with a total reimbursement of 300,000 yuan for hospitalization;

4. Handling process: If the unit pays the full fee, the individual can handle the hospitalization formalities only by paying part of the hospitalization prepayment, and the medical expenses incurred should be in line with the medical insurance coverage. When leaving the hospital, the hospital and the individual will settle the expenses themselves, and the reimbursement amount of the overall fund will be settled by the hospital and the district medical insurance center.

What is social security?

Social security, that is, social insurance, refers to the income or compensation guarantee provided for those who are unable to work, temporarily unemployed or suffer losses due to health reasons. The main items of social security include endowment insurance, maternity insurance, unemployment insurance, medical insurance and industrial injury insurance.

To sum up, first of all, there is an annual ceiling for outpatient reimbursement, 20,000 yuan, which means that the maximum outpatient treatment can reach 20,000 yuan a year.

Legal basis:

Article 2 of People's Republic of China (PRC) Social Insurance Law

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 when they are old, sick, injured, unemployed and have children.

Article 12

The employing unit shall pay the basic old-age insurance premium according to the proportion of the total wages of its employees stipulated by the state, and record it in the basic old-age insurance pooling fund.

Employees shall pay the basic old-age insurance premium in accordance with the proportion of wages stipulated by the state and record it in their personal accounts.

Article 23

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.

Article 33

Employees shall participate in work-related injury insurance, and the employer shall pay the work-related injury insurance premium, and the employees shall not pay the work-related injury insurance premium.