The latest policy of Shanghai Critical Illness Medical Insurance in 2017 1. Scope of application of Shanghai Critical Illness Medical Insurance This notice applies to insured persons who participate in the Shanghai Basic Medical Insurance for Urban Residents and enjoy the benefits of resident critical illness insurance (hereinafter referred to as "insured residents").

2. The agency responsible for resident critical illness insurance (1) Municipal Medical Insurance Management Center (hereinafter referred to as the Municipal Medical Insurance Center) is governed by the Municipal Human Resources and Social Security Bureau (Municipal Medical Insurance Office) (hereinafter referred to as the Municipal Human Resources and Social Security Bureau (Municipal Medical Insurance Office)

)) is entrusted by conducting public bidding through the municipal government procurement center to determine the commercial insurance institution that undertakes resident critical illness insurance; and the municipal medical insurance center signs a resident critical illness insurance entrustment contract with the commercial insurance institution, and implements resident critical illness insurance by purchasing services.

(2) The commercial insurance institution selected by insured residents when they first apply for residents' critical illness insurance reimbursement will be the designated agency for handling resident critical illness insurance medical expense reimbursement that year; once selected, in principle, it should not be changed within the year.

3. Protection benefits of resident critical illness insurance (1) According to the provisions of the "Trial Measures", resident critical illness insurance includes dialysis treatment for severe uremia, anti-rejection treatment for kidney transplantation, malignant tumor treatment (chemotherapy, endocrine-specific treatment, radiotherapy,

Isotope therapy, interventional therapy, traditional Chinese medicine treatment), treatment of some psychiatric diseases (schizophrenia, moderate to severe depression, mania, obsessive-compulsive disorder, mental retardation accompanied by mental disorders, epilepsy accompanied by mental disorders, paranoid psychosis)

.

Starting from September 1, 2015, the medical expenses incurred by students in Shanghai's colleges and universities suffering from hemophilia and aplastic anemia will be included in the coverage of resident critical illness insurance.

(2) The personal responsibility incurred by insured residents suffering from the above-mentioned serious diseases in designated medical institutions of Shanghai Basic Medical Insurance and in compliance with the provisions of Shanghai Basic Medical Insurance will be included in the payment scope of resident serious illness insurance, and 50% will be reimbursed by the critical illness insurance funds.

Among them, insured residents who have participated in the Shanghai Mutual Aid Fund for Primary and Secondary School Students, Infants and Infants Hospitalization Medical Aid Fund should first deduct the payment part of the mutual aid fund.

(3) The payment scope, review and management of resident critical illness insurance shall refer to the relevant regulations on outpatient critical illness of Shanghai Employee Basic Medical Insurance.

4. Reimbursement materials for resident critical illness insurance (1) When insured residents (excluding students in colleges and universities) apply for reimbursement procedures for resident critical illness insurance, they should provide the following materials: 1. Identity card (if you have not received an identity card, please provide other materials)

Valid ID card), "Social Security Card" (or "Social Security Card (for medical insurance only)"); 2. Medical expense receipts that comply with Shanghai Medical Insurance regulations or Shanghai Urban Resident Basic Medical Insurance reimbursement settlement statements; 3.

Outpatient and emergency medical records, discharge summary, detailed list of expenses and other relevant information; 4. When applying for the first time in the year, an agreement to establish a contract service relationship with a community health service center or a community family doctor must be provided; 5. If you entrust others to handle reimbursement matters, the entrusted person must

While providing the above information, the person should also provide the ID card of the entrusted person.

(2) When students in colleges and universities apply for reimbursement procedures for resident critical illness insurance, they should provide the following materials: 1. ID card (if you have not received an ID card, provide other valid ID documents), student ID card; 2. Medical insurance hospitalization settlement voucher

;3. Medical expense receipts or Shanghai Urban Resident Basic Medical Insurance reimbursement settlement forms that comply with Shanghai’s medical insurance regulations; 4. Outpatient and emergency medical records, discharge summaries, detailed expense lists and other relevant information; 5. If you entrust others to handle reimbursement matters,

While providing the above information, the entrusted party must also provide the entrusted party's ID card.

5. Reimbursement process of resident critical illness insurance (1) After insured residents incur serious illness medical expenses, they should apply for reimbursement of serious illness medical expenses from the commercial insurance institution selected by them within six months from the date of issuance of the medical expense receipt, and provide

Corresponding materials.

(2) After accepting the application, the commercial insurance institution will review the medical expenses in accordance with the relevant regulations of Shanghai Resident Critical Illness Insurance.

(3) Commercial insurance institutions shall complete the review, settlement and reimbursement payment of declared medical expenses within 5 working days.

In principle, reimbursement is paid by bank card.

6. Expense settlement and allocation of resident critical illness insurance (1) Settlement of medical expenses 1. Commercial insurance institutions should summarize the reimbursement expenses of resident critical illness insurance on a monthly basis, fill in the expense settlement form and settlement declaration form, and generate computer database data.

2. Commercial insurance institutions shall apply for settlement to the Municipal Medical Insurance Center from the 1st to the 10th of each month with the medical expense settlement form, settlement declaration form and computer database data of the previous month.

3. The Municipal Medical Insurance Center will review the settlement fees declared by commercial insurance institutions in accordance with the relevant regulations of Shanghai Urban Resident Basic Medical Insurance. Fees that do not meet the regulations after review will not be paid; fees that meet the regulations will be allocated before the end of each month.