After the maximum reimbursement of the medical insurance pooling fund, the excess will be reimbursed. The maximum reimbursement limit of medical insurance pooling funds in most areas is 80,000 yuan, and the part exceeding 80,000 yuan is reimbursed by stages according to a certain proportion. The maximum limit is 6.5438+0.8 million. Social security and medical insurance have no classification of diseases, and are only reimbursed according to medical expenses.

It should be noted that whether it is the reimbursement of the overall medical insurance fund or the reimbursement of the serious illness medical assistance fund, it is only for the reasonable part, and the self-funded drugs are not reimbursed. In other words, the expenses for reimbursement are deducted from the self-funded part and reimbursed in proportion.

1, 20 kinds of serious diseases are guaranteed in rural areas, and the reimbursement rate is not less than 90%, including childhood leukemia, congenital heart disease, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, drug-resistant tuberculosis, AIDS opportunistic infection, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction, etc.

2. The serious illness medical insurance policy adjusts the insurance premium financing ratio to: pay supplementary insurance premiums according to 4% of the sum of the actual number of employees insured by the employer and the total wages of employees and retirees in the previous year, and the benefits enjoyed by them shall be implemented with reference to the Interim Measures for Supplementary Medical Insurance for Provincial Employees; The other is based on the employees of the employer, and the supplementary insurance premium is paid at 10% of the total wages of the employees, of which 4% is pre-tax expenses and 6% is after-tax profit retention expenses. The treatment it enjoys shall be implemented with reference to the Interim Measures for Medicaid of civil servants in provincial organs.

Urban workers and urban and rural residents who meet the reimbursement scope of basic medical insurance can enjoy supplementary medical care for serious illness in the medical insurance policy on the basis of saving medical insurance benefits.

Legal basis: Article 23 of the Social Insurance Law of People's Republic of China (PRC).

Employees should participate in the basic medical insurance for employees, and employers and employees should pay the basic medical insurance premiums in accordance with state regulations.

Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.