How does social security reimburse major diseases?

If the accumulated medical expenses of the insured exceed the deductible line of critical illness insurance within one year, the payment shall be made in four phases in principle. That is to say, in a natural year (from 65438+ 10 to 65438+ in February of that year), it can be paid in one lump sum or cumulatively.

For example, the first hospitalization did not reach the deductible line, and the major illness could not be reimbursed, but the second hospitalization cost was large, so the accumulated amount of compliant medical expenses could be reimbursed twice at the same time. Relevant materials shall be prepared for reimbursement:

1, * * * Material: a complete claim application form; Copy of insurance policy; Copy of the insured's ID card (copy of the front and back of the second-generation ID card); Copy of the insured's bank card.

2. Hospitalization: In addition to the commonly used materials, the original diagnosis certificate should be provided, indicating the name of the disease, treatment time and other elements, and stamped with the special seal for hospital diagnosis certificate. If you go to multiple hospitals, each hospital must provide a diagnosis certificate; Original hospital receipt; Detailed summary of expenses; All medical records of hospitalization; If the accident causes hospitalization, it should also be provided. Provide accident-related certificates such as traffic accidents.

3. Outpatient service: In addition to the commonly used materials, the original diagnosis certificate should be provided, indicating the name of the disease, treatment time and other elements, and stamped with the special seal for hospital diagnosis certificate. If you go to multiple hospitals, each hospital must provide a diagnosis certificate; Original report of outpatient acceptance/inspection; Detailed expenses; All outpatient medical records; Information related to the nature of the insured accident. Responsibility certificate, driver's license, driving license and other information.

Extended data:

Non-guaranteed scope

(1) carcinoma in situ;

(2) Chronic lymphoblastic leukemia corresponding to stage A of Binet staging scheme;

(3) Hodgkin's disease equivalent to Ann Arbor stage I;

(4) Skin cancer (excluding malignant melanoma and metastatic skin cancer);

(5) Prostate cancer 5)TNM staging t 1n0m 0≤0 (note);

(6) Malignant tumor during HIV infection or AIDS.

Note: If the critical illness insurance is for women, this item is not included.

acute myocardial infarction

Refers to partial myocardial necrosis caused by insufficient blood supply in the corresponding area due to coronary artery occlusion. At least three conditions must be met:

(1) Typical clinical manifestations, such as acute chest pain;

(2) Recent ECG changes suggest acute myocardial infarction;

(3) Myocardial enzymes or troponin increased in diagnosis, or showed dynamic changes consistent with acute myocardial infarction;

(4) After 90 days of onset, it was confirmed that the left ventricular function decreased, such as the left ventricular ejection fraction was less than 50%.

Baidu encyclopedia-critical illness insurance