Medical mutual assistance refers to medical mutual assistance for serious illness, which is a social medical assistance system established by urban workers on the basis of participating in basic medical insurance to solve the medical expenses of insured patients exceeding the maximum payment limit of the basic medical insurance pooling fund and ensure the medical needs of employees for serious illness.

The key objects of medical mutual assistance for serious illness include:

1. Including the old rural demobilized soldiers who live in the county glorious institute, disabled soldiers who is above the third level in rural areas, the lost personnel of the Red Army, and the veteran cadres in the Soviet area;

2. Rural five-guarantee objects;

3. Rural residents;

4. Urban residents;

5. The poor people identified by the county people's government/have other special difficulties.

Medical insurance is compulsory, and medical mutual assistance is voluntary, which is used for mutual assistance among employees. Generally speaking, it is paid by individuals, and the specific amount may vary due to different local policies.

The scope of reimbursement for trade union medical assistance includes:

1. Outpatient medical expenses: within the scope of basic medical insurance payment (within the maximum payment amount from the deductible line to the capping line), after deducting the deductible line 1800 yuan from the "self-pay one" part, it will be 20% (25% for model workers and extremely poor employees).

2. Hospitalization medical expenses: within the scope of basic medical insurance payment (within the maximum payment amount from the deductible line to the capping line), the "self-pay one" part of the expenses borne by the employees is deducted for the first hospitalization 1.300 yuan (650 yuan is deducted for the second hospitalization; 650 yuan was deducted for the first hospitalization of poor workers, and 325 yuan was deducted for the second hospitalization. After the deductible, the mutual aid is calculated at 20% (25% for model workers and poor workers).

3. Outpatient and inpatient medical expenses above the capping line: After the "self-pay-one" expenses of outpatient and inpatient employees reach the capping line of basic medical insurance, there will still be out-of-pocket expenses within the scope of medical insurance, and 40% of them can enjoy mutual aid from the capping line to 50,000 yuan, with a maximum reimbursement of 20,000 yuan; 50,000 yuan to 654.38+million yuan, you can enjoy 60% mutual aid, and the maximum reimbursement amount is 30,000 yuan; 100000 yuan to 150000 yuan, you can enjoy 80% mutual aid, and the maximum reimbursement amount is 40000 yuan.

The medical assistance reimbursement of the trade union is as follows:

1. The employees themselves, their families or the unit trade union shall apply for subsidies at the service center of the Federation of Trade Unions in time. At the same time, it is necessary to provide an application form for employee medical mutual assistance subsidy, a copy of medical invoice and a copy of hospitalization expense payment and settlement form.

2, the Federation of trade unions staff service center after receiving the materials provided by the insured, audit. After approval, the mutual aid fund shall be paid within 6 working days.

legal ground

People's Republic of China (PRC) social insurance law

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.