Is medical insurance reimbursement for major diseases?

Medical insurance is basic medical care, and commercial critical illness insurance is a supplement to basic medical care.

1, different in nature: medical insurance is consumed first and then reimbursed; A major commercial disease is a one-time payment of an insurance amount that meets the contract conditions, and there is no conflict between the two.

2, the reimbursement amount is different: how much medical insurance will be reimbursed in proportion will definitely not be reported; A major business disease is to insure 500,000 to 500,000, no matter how much you spend.

3, the time is different: the money for medical insurance is discharged; Commercial critical illness insurance is sometimes given without leaving the hospital.

Major diseases covered by medical insurance include: malignant tumor, acute myocardial infarction, sequelae of stroke, major organ transplantation or hematopoietic stem cell transplantation, coronary artery bypass grafting (or coronary artery bypass grafting), end-stage renal disease (or uremia stage of chronic renal failure), multiple limb loss, benign brain tumor, decompensated stage of chronic liver failure, encephalitis sequela's disease or sequelae of meningitis, etc.

Legal basis: Article 23 of the Social Insurance Law of People's Republic of China (PRC), employees shall participate in the basic medical insurance for employees, and the employer and employees shall jointly pay the basic medical insurance premium 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;

(3) borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.

Thirty-first social insurance agencies may, according to the needs of management services, sign service agreements with medical institutions and pharmaceutical business units to standardize medical service behavior.

Medical institutions shall provide reasonable and necessary medical services for the insured.

Thirty-second individuals across the overall regional employment, the basic medical insurance relationship with my transfer, the cumulative payment period.