No disease is limited to the scope of the policy. The medical expenses borne by the insured person’s hospitalization will be included in the reimbursement scope of the critical illness insurance as long as it exceeds the minimum payment standard. No disease is within the scope of the policy. Reimbursement is based on the "three catalogs" of medical insurance in accordance with the principle of treatment based on illness.

There is no cap on the reimbursement of compliant medical expenses incurred by insured persons using the unified fund for medical treatment within an insurance year. After reimbursement by basic medical insurance, the accumulated expenses exceeding the threshold standard will be included in the prescribed reimbursement scope. The reimbursement ratio is:

The reimbursement ratio is 50% for 0-10,000 yuan above the threshold; 10,000-150,000 yuan (including 150,000 yuan), within the range For every additional RMB 10,000, the reimbursement ratio increases by 1 percentage point; for above RMB 150,000, the reimbursement ratio is 70%, with no upper limit.

2. How to reimburse for serious illness through medical insurance

The following information must be prepared for serious illness medical reimbursement:

1. The employee’s "Medical Insurance Card" and "Critical Illness Medical Insurance" Payment Card";

2. Critical Illness Medical Expenses Coordination Fund Disbursement Approval Form (three sheets) (with official seal) and other materials specified by the Critical Illness Medical Expenses Coordination Fund;

3. Discharge Diagnosis certificate (emergency rescue diagnosis certificate should be issued for emergency rescue), hospitalization medical expense settlement list for serious illness patients, special receipt for hospitalization charges and hospitalization expense settlement list (hospitalization reimbursement voucher);

4. Special examination, special Approval forms should be issued for treatment or use of expensive drugs.

Secondly, follow the following procedures:

1. All seriously ill patients, once hospitalized, must send the medical certificate, basic medical insurance diagnosis and treatment manual and other materials to the hospital as soon as possible. Registration and verification by the medical insurance department of the hospital where you live;

2. To apply for outpatient reimbursement for 23 diseases such as liver cirrhosis, insured residents must bring their basic medical insurance diagnosis and treatment manual and the materials required to declare the disease to the regulations Time (please refer to local policies for specific circumstances) to fill in the relevant forms at the medical insurance department of the designated designated hospital for preliminary review;

3. The designated hospital will report the information of insured residents who have passed the preliminary review to the medical insurance agency in each town. Review.

3. What is the reimbursement scope of critical illness medical insurance?

my country's critical illness medical insurance can mainly cover 44 major diseases.

They are cirrhosis, mental illness, myasthenia gravis, multiple sclerosis, pituitary adenoma, polyarteritis nodosa, systemic sclerosis, diabetes insipidus, Henoch-Schonlein purpura and nephropathy, chronic kidney disease Insufficiency, polycythemia vera, Behcet's disease, hemolytic anemia, panniculitis, motor neuron disease, idiopathic pulmonary fibrosis, Parkinson's disease, systemic lupus erythematosus, chronic aplastic anemia, malignant Tumors, leukemia, tuberculosis and other serious diseases.

4. How to apply for critical illness insurance after medical insurance reimbursement

Critical illness insurance reimbursement process

1. Insured persons need to bring the above materials to the medical insurance department of the local designated hospital to fill out relevant The form will undergo preliminary review;

2. Designated hospitals will submit the information of insured residents who have passed the preliminary review to each urban medical insurance agency for review;

3. Insured residents who have passed the final review will be submitted to each urban medical insurance agency for review. The insurance agency organizes the disbursement of critical illness medical insurance reimbursements.

Major illness medical insurance reimbursement process:

1. After a patient with a serious illness is hospitalized, he or she must submit the diagnosis certificate, basic medical insurance diagnosis and treatment manual and other materials to the medical insurance department of the hospital where he or she is staying for registration and review as soon as possible , so as not to affect the reimbursement of hospitalization medical expenses.

2. Outpatient medical expenses need to be applied for reimbursement according to the prescribed time. There are two opportunities to apply for outpatient reimbursement a year for 23 diseases such as liver cirrhosis, and one application opportunity for 7 types of diseases such as leukemia at the end of each quarter.