Medical assistance for serious illness refers to a new medical assistance system that relies on the basic medical insurance for urban residents (employees) and the settlement platform of the new rural cooperative medical system, with stable capital investment, * * * using the service platform, * * * enjoying information resources, synchronizing settlement and payment, standardized management and operation, obvious relief effect, fast service for people with difficulties and scientific coverage of urban and rural areas.

Payment and reimbursement amount of serious illness assistance:

1, paid by the employer and the insured according to the standard of 96 yuan per person per year.

2. The medical expenses incurred by the insured in a statistical year that exceed the maximum payment limit of the basic medical insurance pooling fund and are in medical insurance coverage shall be paid by the medical insurance for serious illness relief, with the insured paying 10% and the maximum payment limit of 200,000 yuan.

The provisions on the settlement management of medical assistance expenses for serious illness are as follows:

(a) medical assistance for serious illness on the basis of basic medical insurance compensation and large Medicaid subsidies, with the help of medical insurance management platform to standardize the operation, forming a multi-level settlement system.

All designated medical institutions and social insurance agencies enter all medical expenses information of insured patients in designated medical institutions into the medical insurance information management system in accordance with medical insurance regulations and standardized information recording methods, and provide "one-stop" services integrating medical services, medical insurance settlement and serious illness medical assistance settlement for rescue objects through the information management platform, and provide unified medical insurance and assistance settlement documents.

(two) special drugs, special materials relief does not set up a relief deductible.

(three) the settlement of the expenses of special drugs and special materials assistance shall be carried out by accounting. At the time of settlement, the relief object pays part of the expenses borne by the individual, and other expenses are paid in advance by the special pharmacy and settled with the social insurance agency on a monthly basis. Included in the rescue of special drugs, special materials costs, not included in the medical insurance hospitalization settlement or outpatient serious illness settlement management.

(IV) Settlement of special medical assistance expenses. Except for the special drug expenses of special pharmacies, other clinical examination, inspection, treatment and drug expenses that the insured patients meet the requirements of outpatient serious illness management shall be settled in the designated outpatient serious illness hospital according to the relevant provisions of medical insurance settlement management.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.