How to reimburse medical insurance for serious illness?

The critical illness reimbursement process of medical insurance usually includes the following steps:

1. Report the case. Once diagnosed as a major illness, the insured person needs to report the case to the social security department immediately and apply for medical reimbursement for serious illness.

2. Submission of materials. After all seriously ill patients are hospitalized, they must send the medical certificate, basic medical insurance diagnosis and treatment manual and other materials to the medical insurance department where they are hospitalized for registration and verification as soon as possible.

3. Outpatient medical expenses reimbursement. The reimbursement process of outpatient medical expenses is similar to that of inpatient medical expenses, and it is necessary to apply for reimbursement according to the specified time. Some diseases, such as liver cirrhosis, have a specific application time.

4. Reimbursement process. Insured persons need to bring their ID card, medical insurance or medical insurance card, original and photocopy of medical expense settlement list, and go to the medical insurance department of local designated hospital to fill in relevant forms for preliminary examination. After that, the designated hospital will report the qualified data in the first instance to the urban medical insurance agency for review. The insured persons who pass the final examination shall be reimbursed by the urban medical insurance agency.

The scope of reimbursement for serious illness medical insurance is as follows:

1. Malignant tumor treatment: including chemotherapy (including endocrine-specific anti-tumor therapy), radiotherapy, isotope anti-tumor therapy, interventional anti-tumor therapy and traditional Chinese medicine anti-tumor therapy.

2. Outpatient hemodialysis and peritoneal dialysis for severe uremia.

3. Anti-rejection therapy after renal transplantation.

4. Treatment of severe mental illness: schizophrenia, depression (moderate or severe), mania, obsessive-compulsive disorder, mental retardation with mental disorder, epilepsy with mental disorder, paranoid psychosis.

To sum up, for major diseases, the medical insurance involved in hospitalization is generally reimbursed according to the standard of 90%, and it should be noted that not all drugs can be reimbursed at the time of reimbursement.

Legal basis:

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

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, 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.