What is the proportion of reimbursement for serious illness in social security?

The proportion of social security reimbursement for serious illness is determined according to the actual total medical expenses. Under normal circumstances, expenses below 40,000 can be reimbursed by 85%, expenses up to 40,000-80,000 can be reimbursed by 90%, and expenses above 80,000 can be reimbursed by 95%. Please consult the staff of social security department for details.

1. What is the proportion of reimbursement for serious illness in social security?

The proportion of reimbursement for serious illness in social security is: 85% below RMB 0-40,000, 90% below RMB 40,000-80,000, and 95% above RMB 80,000. The maximum payment limit for each medical year is 6,543,800 yuan+0.5 million yuan. The reimbursement scope of serious illness medical insurance mainly covers medical expenses exceeding the maximum payment limit of the basic medical pooling fund. The reimbursement ratio will vary according to the amount paid by the social security department in different ranges.

Second, the provisions of the social security insurance law on medical insurance.

Twenty-third 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 24 The state establishes and improves the new rural cooperative medical system.

Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.

Article 25 The state establishes and improves the basic medical insurance system for urban residents.

The basic medical insurance for urban residents combines individual contributions with government subsidies.

People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.

Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

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;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

The specific scope and standards of social security reimbursement for serious illness need to be strictly implemented according to law. When the parties enjoy medical insurance, they can use it to submit social security reimbursement according to the actual medical expenses incurred after medical treatment, which will be written off by the social security department according to the actual situation.