What diseases does the critical illness insurance in social security include?

At present, social medical insurance is not universal in China, but different social security strategies are formulated by provinces and cities, so serious illness insurance in different provinces and cities may include different diseases.

Generally, the social security critical illness insurance in various places generally includes all kinds of malignant tumors, hematological leukemia, aplastic anemia, congenital heart disease, acute myocardial infarction, cerebrovascular diseases such as cerebral infarction, cerebral hemorrhage and other serious sequelae, as well as severe burns or deep coma, organ transplantation, etc., all of which belong to the insurance scope of critical illness insurance.

Specific diseases should be consulted with local medical insurance institutions or social security bureaus, and the scope of reimbursement for general critical illness insurance is the reimbursement for hospitalization consumption.

Social medical insurance is also called "sickness social insurance" or "health social insurance". A social insurance in which the income of the insured is interrupted and the medical expenses are lost due to illness, injury, disability, etc. Insurance institutions provide material assistance. Including disease subsidies and health care, that is, payment for medical care, special medical care, outpatient service, hospitalization, home care services and drug supply. Due to the different levels of national economic development and social systems in different countries, the scope of disease insurance varies greatly. Some countries include the whole people, while others are limited to employed workers. Most countries stipulate that the source of funds is shared by employees and employers, and the state gives certain subsidies.

brief introduction

Social medical insurance is a medical insurance system enforced by the state through legislation. Employers and individuals pay insurance premiums according to a certain proportion, establish social medical insurance funds, and pay medical expenses for employees.

Social medical insurance means that when workers get sick, social insurance institutions give appropriate subsidies or reimbursement for their medical expenses, so that workers can recover their health and labor ability as soon as possible and enter the process of social reproduction. Social medical insurance is an important part of social insurance, which is generally borne by the government. The government will use economic, administrative and legal means to implement and organize.

Settlement procedure

Special diseases

Designated medical institutions should report the expense list, hospitalization list and related materials of patients discharged from hospital last month to the medical insurance agency before 10 every month, which will be used as the basis for monthly pre-allocation and year-end settlement after examination. The medical insurance agency pre-allocated the hospitalization and outpatient expenses for special diseases last month. Insured persons who have been identified as suffering from special diseases shall go to the designated medical institutions designated by the labor and social security departments for medical treatment and medicine purchase, and the medical expenses incurred shall be directly recorded and settled immediately.

Emergency settlement

The medical expenses incurred by the insured due to emergency rescue to non-designated medical institutions in the city and medical institutions in different places shall be paid in advance by individuals or units. After the emergency rescue, the medical insurance agency shall handle the reimbursement procedures according to the provisions with the emergency hospitalization medical records, inspection, laboratory test sheets, invoices and detailed list of medical expenses.

Foreign personnel

1. The personnel resettled in different places shall be designated as the designated medical institution of 1-2 by the unit to which they belong, and shall be reported to the medical insurance agency for the record.

2. The medical expenses incurred by the off-site staff in the outpatient department of the designated medical institution where the disease occurs at the place of residence shall be paid in advance by themselves or their units. After the treatment, the unit shall settle the diagnosis and medical records, effective expense bills, compound prescriptions and hospitalization expense lists of the insured. Go to the social medical insurance agency on the specified date.