Conditions for participation in medical insurance: Critical illness medical insurance reimbursement scope: Insured persons who have one of the following circumstances will enjoy outpatient critical illness benefits: 1. Outpatient dialysis for chronic renal failure; 2. After organ transplantation that is included in the scope of medical insurance payment

Anti-rejection drugs for outpatient use; 3. Outpatient chemotherapy, interventional therapy, radiotherapy or radionuclide therapy for malignant tumors; 4. Specialist outpatient treatment for hemophilia; 5. Specialist outpatient treatment for aplastic anemia; 6. Specialist outpatient treatment for thalassemia; 7

, specialized outpatient treatment for benign intracranial tumors 8, other serious illnesses, etc.

What are the situations in which serious illness medical insurance cannot reimburse? 1. Seeking treatment in non-designated hospitals without approval (except for emergency rescue); 2. Suffering from occupational diseases, work-related injuries or relapse of old work-related injuries; 3. Injuries caused by traffic accidents;

4. Injuries caused by personal violations; 5. Food poisoning due to accidents caused by liability; 6. Treatment due to suicide; 7. Injuries caused by medical accidents; 8. Medical expenses should be borne by oneself according to the regulations of the country and this city.

Processing materials: 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); 3. Discharge diagnosis is correct (emergency rescue response)

Issue emergency rescue diagnosis (correct), "Inpatient medical expense settlement list for serious illness patients", "Beijing special receipt for hospitalization charges" and "hospitalization bill" (hospitalization reimbursement must be certified); 4. Special examination, special treatment or use

Approval forms should be issued for expensive drugs; 5. Outpatients must provide a positive diagnosis, a prescription for serious illness coordination, and a special receipt for outpatient fees in Beijing; 6. Transfer treatment should provide a transfer certificate issued by the hospital's serious illness coordination office; 7. Medical coordination for serious illness

Other materials as specified.

8. The time limit for document reimbursement is 60 days based on the last day of discharge or outpatient service. No reimbursement will be made after the deadline; 9. A one-time reimbursement system is implemented for serious illness medical expenses, and any omissions caused by enterprises, individuals, or hospitals will not be reimbursed; 10

. If the reimbursement materials are incomplete due to enterprises, individuals or hospitals, payment will be suspended.

Process: Once hospitalized, all patients with serious illnesses must submit their medical certificate, basic medical insurance diagnosis and treatment manual and other materials to the medical insurance department of the hospital where they are staying for registration and review as soon as possible, so as not to affect the reimbursement of hospitalization medical expenses; apply for 23 types of liver cirrhosis, etc.

For outpatient reimbursement of diseases, insured residents must bring their own basic medical insurance diagnosis and treatment manual and the materials required to declare the disease to the designated hospital’s medical insurance department in May and November each year to fill in the relevant forms for preliminary review; the designated hospital will enroll those who pass the preliminary review for insurance

Resident information is submitted to each urban medical insurance agency for review.

The insured residents who pass the final review will be issued a "Taiyuan Basic Medical Insurance Outpatient Specific Disease Medical Certificate" by each urban medical insurance agency, which will take effect after being stamped, and they will enjoy outpatient chronic disease treatment starting from July and January.

Reimbursement ratio standard The actual payment ratio of critical illness insurance shall not be less than 50%. In terms of the coverage of critical illness insurance for urban and rural residents, the "Opinions" pointed out that the coverage objects of critical illness insurance are insured (joint) persons of urban residents' medical insurance and new rural cooperative medical insurance, and the scope of coverage is

It should be connected with urban residents’ medical insurance and new rural cooperative medical insurance.

Urban residents' medical insurance and new rural cooperative medical insurance should provide basic medical security in accordance with policy regulations.

On this basis, critical illness insurance mainly protects the qualified medical expenses that need to be borne by the individual after compensation from urban residents' medical insurance and New Rural Cooperative Medical Insurance when the insured person suffers from a serious illness and incurs high medical expenses.

In addition, the level of critical illness insurance protection is aimed at avoiding catastrophic household medical expenses for urban and rural residents, and the compensation policy for critical illness insurance is reasonably determined. The actual payment ratio is not less than 50%; the payment ratio is determined according to the level of medical expenses. In principle, medical expenses

The higher the ratio, the higher the payment ratio.