What is social security supplementary medical insurance for serious illness?

Today, I will tell you about the supplementary medical insurance for critical illness, because I think many people may not think of this insurance. After all, our understanding of medical insurance is limited to basic medical insurance and critical illness insurance, and we don't pay much attention to supplementary medical insurance for critical illness. Today, I will discuss this issue with you.

Social medical insurance mainly consists of three parts: basic medical insurance, large medical mutual assistance and supplementary medical insurance. Among them, the large medical mutual fund is used to improve the medical security level of employees and retirees and reduce the personal burden. Supplementary medical insurance is established by enterprises in order not to reduce the existing medical treatment level of employees and ensure the smooth transition of medical insurance system. It is a supplementary form of basic medical insurance and large medical mutual assistance.

What is critical illness supplementary medical insurance?

Supplementary medical insurance for serious illness refers to the medical expenses incurred by insured workers in designated medical institutions due to illness, which meet the requirements of basic medical insurance, and exceed the maximum payment limit of basic medical insurance pooling fund (tentative 36,000 yuan) in a natural year, with the amount of 0- 1.5 million yuan. All units and individuals who participate in the basic medical insurance can participate in the supplementary medical insurance for serious illness. It is an important supplement to the basic medical insurance, which means that 90% of the medical expenses of the insured within a natural year (65438+ 10/to 65438+February 3 1) are reimbursed by the supplementary insurance fund. Greatly reducing the economic burden of patients.

Relationship between supplementary medical insurance for serious illness and basic medical insurance

The supplementary medical insurance for serious illness is relative to the basic medical insurance, including enterprise supplementary medical insurance, commercial medical insurance, social mutual assistance and community medical insurance. It is a powerful supplement to the basic medical insurance and an important part of the multi-level medical security system. Different from basic medical insurance, supplementary medical insurance is not enforced by national legislation, but is voluntarily participated by employers and individuals.

After the units and employees participate in the unified basic medical insurance, the units or individuals shall appropriately increase the medical insurance items according to the needs and possible principles, and improve the level of insurance protection. Basic medical insurance and supplementary medical insurance are not contradictory, but complementary and irreplaceable, and their purpose is to provide medical security for employees.

Fund raising and management

1. The basic medical insurance and large medical mutual fund are jointly paid by units and individuals, subsidized by the government, managed by the district social security center and used according to the unified reimbursement standard.

2, supplementary medical insurance premiums from the insured units to extract a certain proportion of total wages, formulate policies for management.

Reimbursement policy of supplementary medical insurance for serious illness

Urban workers: 75% of the total one-time hospitalization expenses (except for special medical materials with individual self-paid unit price 1 10,000 yuan or more)-all at their own expense-the amount paid by the basic medical insurance pooling fund);

Urban and rural residents: 75% of the total one-time hospitalization expenses (excluding special medical materials with a unit price of 1 10,000 yuan or more)-all at their own expense-the part paid by the basic medical insurance pooling fund is calculated according to the third payment of urban and rural residents);

Insured persons who have not participated in the basic medical insurance: [Total one-time hospitalization expenses (excluding special medical materials with a unit price of 1 10,000 yuan or more, which shall be paid by individuals first)-all at their own expense-75% paid by the overall fund calculated according to the basic medical insurance for urban workers in this city].

What items belong to the reimbursement scope of supplementary medical insurance for serious illness?

Hospitalization expenses, outpatient special disease expenses, outpatient rescue invalid death, family beds, personal out-of-pocket medical expenses (including Qifubiaozhun expenses) meet the basic medical insurance payment scope and medical expenses exceeding the maximum payment limit and meeting the basic medical insurance payment scope are included in the reimbursement scope.

The above is all about the supplementary medical insurance for serious illness, and I hope it will help you.