Many people know that minor diseases are easy to solve, but hundreds of thousands of millions of treatment fees are hard to bear for ordinary working families. There is reimbursement proportion of serious illness medical insurance in social security, so which diseases can be reimbursed?
What diseases does serious illness medical insurance include?
In order to reduce the economic burden of the residents, the state has included some major diseases into the scope of serious illness medical insurance, including 20 kinds of diseases: childhood leukemia, congenital heart disease, end-stage kidney disease, breast cancer, cervical cancer, serious mental disease, drug-resistant tuberculosis, and AIDS opportunism Infection, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction, colon cancer, rectal cancer.
Reimbursement proportion of serious illness medical insurance
In the proportion of reimbursement, the patients with serious illness need to pay more than 50% of the reasonable medical expenses after the reimbursement of basic medical insurance. In principle, the higher the medical expenses are, the higher the proportion of payment will be. The compensation base shall be the part over 5000 yuan of personal responsibility. The reimbursement proportion increases by stages. The compensation base is RMB 10000 (including RMB 10000) for 50%; RMB 10000 (including RMB 20000) for 55%; RMB 20000 (including RMB 50000) for 60%; and RMB 50000 (including RMB 50000) for 65%. If urban and rural residents seek medical treatment in medical institutions below the municipal level, they shall be compensated by increasing the proportion of reimbursement by 5% and 10% respectively at the municipal and county levels. The reimbursement amount is not capped. According to the mode of "basic medical insurance + serious illness medical insurance + medical assistance", the actual reimbursement proportion of hospitalization expenses of urban and rural residents shall be continuously increased.
All medical expenses are calculated by 600000 yuan. How much will be reimbursed for participating in medical insurance for serious illness of employees?
1. Basic medical part:
10000 yuan (at one's own expense) + 15000 yuan (at one's own expense) + 1600 yuan (starting line) = 26600 yuan, which is the pure personal cost.
The proportion of basic medical reimbursement for ordinary adults in tertiary hospitals is 80%, so (600000-26600) & times; 80% = 458720 yuan, the annual payment limit of employee medical insurance is 418000 yuan, and the actual payment is 418000 yuan.
2. The excess part will enter the serious illness insurance system and will be reimbursed at 95%.
(458720-418000) & times; 95% = 38684 yuan.
Therefore, in this case, the total reimbursement amount of the employee's serious illness medical insurance is 418000 + 38684 = 456684 yuan.
How to reimburse medical insurance for serious illness
In order to facilitate the discharge of urban and rural residents to achieve the connection between basic medical insurance, serious illness insurance and medical assistance, the implementation plan clearly stipulates that urban and rural residents in the information-based interconnection and can carry out immediate medical treatment in medical institutions: on admission, insurance certificate, identity certificate, minimum living security certificate, support certificate for the extremely poor, one card, bank account, etc. will be delivered to the doctor together If the hospital's own expenses fail to reach the starting line of 5000 yuan serious illness insurance after one or more hospitalization, it shall provide one-stop service in accordance with the process of "basic medical insurance and medical assistance"; if the individual's own expenses exceed the starting standard for a single hospitalization, the commercial insurance agency shall timely compensate the serious illness medical insurance expenses; If the self expense of single hospitalization compliance does not exceed the starting line, but the part that has been hospitalized for many times during the year and has exceeded the starting standard accumulatively, the insurance institution shall give one-time compensation at the end of the settlement year, and carry out one-stop service in accordance with the flow of "basic medical insurance, serious illness insurance and medical assistance".
We can know that the serious illness medical insurance is a necessary supplement to the basic medical insurance through the knowledge of how to reimburse the employees' serious illness medical insurance in 2018 detailed in the small edition above. All units participating in the basic medical insurance for employees of organs and institutions and their insured employees must participate in the serious illness medical insurance for employees. The medical insurance for serious illness shall be organized and implemented by the medical insurance center. According to the standard of 72 yuan per person per year, the serious illness medical co-ordination fund shall be borne by the insured units, of which the subsidy allocated by the county finance shall be taken as the subsidy for civil servants and borne by the county finance.