What is the coverage of Shanghai residents' serious illness insurance?

First, serious illness medical insurance is a special medical insurance fund established to ensure the medical needs of urban workers for major diseases, which is used to pay the medical expenses accumulated by the insured who participate in the basic medical insurance for urban workers during the year that exceed the maximum payment limit of basic medical insurance (excluding out-of-pocket expenses).

Second, according to the regulations:

Medical expenses incurred under any of the following circumstances do not belong to serious illness in medical insurance coverage:

1. Those who seek medical treatment in non-designated hospitals without approval (except emergency rescue);

2. Party B suffers from occupational disease, work-related injury or relapse of work-related injury;

3. Injuries caused by traffic accidents;

4. Injuries are caused by my violation of the law;

5. Food poisoning caused by accident;

6. Treatment due to suicide;

7. Injuries caused by medical accidents;

8. according to the regulations of the state and this municipality, medical expenses should be paid by themselves.

Third, diseases that can be included in the reimbursement scope of medical insurance for serious illness:

Not all diseases are "serious illness", nor can they all be reimbursed. China's insurance industry has unified and standardized the expressions of the 25 most common diseases in critical illness insurance products. The names of these 25 diseases are as follows:

1. Malignant tumor-excluding some early malignant tumors

2. Acute myocardial infarction

3. Sequela of stroke-permanent dysfunction

4. Major organ transplantation or hematopoietic stem cell transplantation-allogeneic transplantation

5. Coronary artery bypass grafting (or coronary artery bypass grafting)-must be performed. -dialysis treatment or kidney transplantation

7, multiple limbs missing-complete amputation

8, acute or subacute severe hepatitis

9, benign brain tumor-requiring craniotomy or radiotherapy

1, decompensated period of chronic liver failure-excluding sequelae of alcoholism or drug abuse

11, encephalitis sequela or meningitis-permanent dysfunction

. Deep coma-excluding alcoholism or drug abuse

13, binaural deafness-permanent irreversibility