Coverage of medical insurance for employees with serious illness:
Serious illness medical insurance is a special medical insurance fund set up to protect the medical needs of urban workers for major diseases, which is used to pay the medical expenses (excluding out-of-pocket expenses) that the insured who participated in the basic medical insurance for urban workers exceeded the maximum payment limit of basic medical insurance (40,000 yuan) during the year. Every insured person who participates in the basic medical insurance pays the medical insurance premium for serious illness to the municipal and district social insurance bureaus every year in 48 yuan. Medical expenses exceeding the maximum payment limit of the basic medical pooling fund shall be reimbursed by the social security department for 85% below RMB 0-40,000, 90% below RMB 40,000-80,000 and 95% above RMB 80,000. The maximum payment limit for each medical year is 6.5438 yuan +0.5 million yuan.
Units participating in medical insurance for serious illness must strictly follow the provisions of Beijing Municipality on Social Overall Planning of Medical Expenses for Serious Illness of Employees and Retirees of Local Urban Enterprises (Order No.6 of Beijing Municipal People's Government +65438) and relevant documents. This Ordinance aims to provide basic medical insurance for employees and retirees of enterprises in Bao Zheng when they are seriously ill.
To sum up, employees' medical insurance participants can also participate in critical illness insurance. This means that employees can not only enjoy the basic medical security of employee medical insurance, but also increase additional security by purchasing critical illness insurance to cope with possible major diseases.
Legal basis:
Social insurance law
Article 28
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
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.