Scope of reimbursement for serious illness assistance

The scope of reimbursement for serious illness assistance is as follows:

1, malignant tumor;

2. Acute myocardial infarction;

3. Sequela of cerebral apoplexy;

4. Major organ transplantation or hematopoietic stem cell transplantation;

5. Coronary artery bypass grafting;

6. End-stage renal disease (or uremia stage of chronic renal failure);

7. Multi-limb loss;

8. Acute or subacute severe hepatitis;

9. Benign brain tumor;

10, decompensated stage of chronic liver failure;

1 1, encephalitis sequela or sequelae of meningitis;

12, deep coma;

13, binaural deafness;

14, blindness in both eyes;

15, paralysis;

16, heart valve surgery, etc.

Medical insurance reimbursement conditions are as follows:

1, the insured person must go to the designated medical institution of basic medical insurance or the designated retail pharmacy determined by the social insurance institution with the medical prescription issued by the doctor in the designated hospital;

2. The medical expenses incurred by the insured in the process of medical treatment must conform to the scope and payment standards of the basic medical insurance drug list, medical treatment items and medical service facilities standards, and can be paid by the basic medical insurance fund according to regulations;

3. The medical expenses incurred by the insured that meet the payment scope of basic medical insurance shall be paid by the social medical pooling fund in a unified proportion, with the expenses above the Qifubiaozhun and below the maximum payment limit.

Medical insurance generally refers to basic medical insurance, which is a social insurance system established to compensate workers for economic losses caused by disease risks. The medical insurance fund is established through the contributions of employers and individuals. After the insured person has medical expenses, the medical insurance institution will give certain economic compensation.

legal ground

People's Republic of China (PRC) social insurance law

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.