For some particularly expensive serious diseases, China will establish a supplementary medical insurance reimbursement system, which will be reimbursed again on the basis of basic medical insurance reimbursement, and the actual reimbursement ratio is required to be no less than 50%. In-service employees' reimbursement rate for hospitalization medical insurance hospitalization, except for the self-funded part and the self-paid 10% of class B expenses, the part exceeding the hospital medical insurance deductible line enjoys the proportion of overall payment, and the proportion of overall payment is different at different hospital levels. The proportion of medical insurance for employees is over 80% (82%/84%/87% in Wuhan), and that for residents is about 70% (80%/65%/50% in Wuhan).

Medical insurance reimbursement process for serious illness:

1. After a seriously ill patient is hospitalized, he must send the medical certificate, his basic medical insurance diagnosis and treatment manual and other materials to the medical insurance department of the hospital where he lives for registration and verification, so as not to affect the reimbursement of hospitalization medical expenses.

2. Outpatient medical expenses need to be reimbursed according to the specified time. There are two outpatient reimbursement opportunities at the end of each quarter for 23 diseases such as liver cirrhosis and 7 diseases such as leukemia.

A. To apply for outpatient reimbursement for 23 diseases such as liver cirrhosis, the insured residents should go to the medical insurance department of the designated hospital to fill in the relevant forms in May and June 165438+ 10 every year for preliminary examination; Designated hospitals will report the information of insured residents who have passed the preliminary examination to the urban medical insurance agency for review. The insured residents who finally pass the examination and approval shall be organized by the urban medical insurance agency to issue the "Outpatient Medical Certificate of xx Basic Medical Insurance for Specific Diseases", which will take effect after being sealed, and they will enjoy the outpatient treatment of chronic diseases from July and June of 5438+ 10.

B. To apply for outpatient reimbursement of seven diseases, such as leukemia, the insured residents should hold their own basic medical insurance diagnosis and treatment manual, and bring the materials needed for applying for diseases to the medical insurance department of the first-visit hospital for preliminary examination at the end of each quarter, and fill out relevant forms after passing the preliminary examination. Issue "xx Basic Medical Insurance Outpatient Specific Disease Medical Certificate" to eligible outpatients with chronic diseases, and enjoy relevant treatment according to the corresponding time.

Take uremia as an example, patients should be hospitalized first. The reimbursement rules for hospitalization expenses are as follows: A-A hospitals begin to reimburse above 200 yuan, and the reimbursement rate that meets the policy is 85%; Secondary hospitals began to reimburse 400 yuan, and the reimbursement rate in line with the policy was 70%; Third-class hospitals exceeded 800 yuan and began to reimburse, and the reimbursement rate in line with the policy was 60%. "This reminds patients to see the hospital level clearly when choosing a hospital." According to a person from Taiyuan Medical Insurance Management Service Center, the average uremia patient spends more than 20,000 yuan in hospitalization (dimethyl) and nearly 80,000 yuan in late renal dialysis, totaling about 65,438+10,000 yuan. These medical expenses, urban residents' medical insurance can reimburse a total of about 65 thousand, and bear about 35 thousand by themselves.

Legal basis: Article 6 of the Measures for the Administration of Social Security Cards of the People's Republic of China (hereinafter referred to as card-issuing areas) shall establish standardized human resources and social security business processes with strong comprehensive coordination among businesses, which can ensure the effective application of social security cards. At the same time, it should also meet the following technical conditions: (1) establish a business management system, database and information network suitable for the use of social security cards; (two) have the technical force to support the management and application of social security cards, including personnel and equipment, and be able to quickly complete the system layout of social security card applications; (3) Formulating standardized and feasible implementation plans, including application design plans, cost solutions, information collection plans and specific distribution plans; (four) to establish a scientific and perfect social security card issuance management system and clear internal control procedures, and formulate emergency plans; (5) Other conditions stipulated by Ministry of Human Resources and Social Security.