Does cerebral hemorrhage belong to the reimbursement scope of serious illness insurance?

Cerebral hemorrhage can generally be reimbursed, but whether it belongs to the scope of serious illness depends on the patient's condition. Generally, serious illness belongs to the scope of serious illness.

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The reimbursement scope of serious illness medical insurance mainly refers to the medical expenses that exceed 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, including: 85% for reimbursement below RMB 0-40,000, 90% for reimbursement below RMB 40-80,000, and 95% for reimbursement above RMB 80,000. The maximum payment limit for each medical year is 6,543,800 yuan+0.5 million yuan.

Retirees who do not pay the basic medical insurance premium and continue to enjoy the basic medical insurance benefits are not in the "serious illness medical insurance coverage". Serious illness medical care can be divided into two types from the form of insurance. One is serious illness social insurance, which is a special medical insurance fund set up to ensure the medical needs of urban workers for major diseases, and is used to pay the insured who participate in the basic medical insurance for urban workers. The other is the serious illness medical treatment in commercial insurance, which is the major illness protection that the insurance company underwrites for a specific insurer according to the insurance clauses. It should be noted that the explanations of these two major diseases within the scope of medical insurance coverage are not exactly the same, and consumers should make clear choices when insuring and using them.

Among them, the reimbursement of social security expenses within the scope of medical insurance requires invoices of actual medical expenses, which are divided into reimbursement of hospitalization expenses and reimbursement of ordinary outpatient and emergency expenses, as well as large medical co-ordination, with certain limits; It is different from commercial insurance. As long as the hospital diagnoses a serious illness on the policy, it can pay in full according to the contract. However, social security is limited and can only provide basic protection, while commercial insurance can pay according to the insured's own insurance amount.

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