The details of protection are as follows:
1. Supplementary medical insurance for critical illness insurance: 80% of the medical expenses for critical illness incurred by the insured in the specified medical institution that need to be borne by the individual after medical insurance settlement and deduction of the corresponding deductibles are guaranteed to be reimbursed, with a maximum cumulative reimbursement of 1.2 million yuan;
2. Supplementary medical insurance for drugs and materials other than hospitalization and specific outpatient medical insurance: after deducting the deductible of 654.38 yuan +0.2 million yuan, 65% will be reimbursed within 20,000 yuan, 75% will be reimbursed above 20,000 yuan, and the maximum reimbursement will be 6.5438 yuan +0.2 million yuan;
3. Medical insurance for innovative drugs and consumables for specific tumor and critically ill patients: for the high expenses of innovative drugs and consumables within the scope of this insurance, after deducting the deductible 1 1,000 yuan, the remaining self-funded part can be reimbursed by 60%, with a maximum reimbursement of 500,000 yuan;
4. Medical insurance for exclusive drugs for three kinds of rare diseases: after deducting the deductible of RMB 654.38+RMB 00,000, the expenses for three kinds of special drugs agreed in this agreement will be reimbursed at the rate of 60%, with a maximum reimbursement of RMB 654.38+RMB 00,000.
Xihu Yilianbao is reimbursed as follows:
1, system networking "one-stop settlement", refers to the expenses that meet the medical responsibility in Hangzhou by swiping the basic medical insurance in real time, which can be settled in medical institutions, and the supplementary medical insurance that meets the serious illness outside Hangzhou can be settled by swiping the basic medical insurance in real time.
2. Sporadic reimbursement settlement refers to the medical expenses that the insured does not meet the credit card one-stop settlement and meets the claim conditions, and needs to bring materials to the special window of the service outlets announced by the insurance company.
3. Reimbursement afterwards. For those who meet the medical insurance for serious illness and the expenses exceed 13000 to 25000, as well as self-funded medical treatment items and self-funded materials outside the medical insurance, this method is adopted, and there is no need to provide claims information.
4. Special medicine claim is to upload the image claim data on the public micro-signal of West Lake Yilian Film, and then click on the service center, claim service and innovative medicine consumables cost guarantee. The proton heavy ion therapy fee is to submit paper materials at the counter of China Life Insurance or upload materials on WeChat official account.
Legal basis:
Medical security law
Article 37? Designated medical institutions shall provide reasonable and necessary medical services for the insured, implement the prescribed price policy, improve service quality, rationally and effectively use medical security funds, and safeguard citizens' health rights and interests. Under the premise of meeting clinical needs, designated medical institutions should give priority to the medical services that can be paid by the medical security fund.
Article 38? Designated medical institutions shall establish an internal management system of medical security funds, and specialized agencies or personnel shall be responsible for the management of medical security funds, and establish and improve the assessment system.
Designated medical institutions shall organize training on relevant systems and policies of medical security funds, regularly check the use of medical security funds of their own units, and promptly correct the irregular use of medical security funds.