He went to the medical insurance center for serious illness in 2
Publish: 2021-04-28 20:52:28
1. In 2020, will medical insurance only show employee medical insurance and serious illness
endowment insurance inquiry:
if you are not clear about your social security account number, you can bring your ID card to the business hall of social insurance agencies in each district for inquiry
online query: log in to the labor and social security network or social insurance business website of your city, click the "personal social security information query" window, and enter your ID card and password (the password is your social security card number or ID card date of birth), then you can query your insurance information
telephone consultation: call "12333" for policy consultation and information inquiry; Indivial account statement: every year, the social endowment insurance center will send the indivial account statement to each insured person, and check the payment and account records through the indivial account statement.
endowment insurance inquiry:
if you are not clear about your social security account number, you can bring your ID card to the business hall of social insurance agencies in each district for inquiry
online query: log in to the labor and social security network or social insurance business website of your city, click the "personal social security information query" window, and enter your ID card and password (the password is your social security card number or ID card date of birth), then you can query your insurance information
telephone consultation: call "12333" for policy consultation and information inquiry; Indivial account statement: every year, the social endowment insurance center will send the indivial account statement to each insured person, and check the payment and account records through the indivial account statement.
2. The civil affairs subsidy is not based on the amount of money paid at one's own expense. It is the self financing part of the medical insurance. After the amount is full, it will be reimbursed in proportion. The self financing part of medical insurance is the expense after decting the medical insurance fund after excluding the self financing items. It also depends on the proportion of local reimbursement.
3. As long as it is within the limited reimbursement scope of serious illness medical insurance, it can go through the medical insurance reimbursement after passing the review and approval.
4. In 2020, Changshu normal medical insurance patients should have risks, which should not be unlimited, so this should have a certain landscape, in order to better the rules.
5. This is a place where the standards are different, so they are generally different
6. Your question is not accurate. 1. You mean large amount of medical insurance. 2. Overall planning of serious illness of medical insurance
1. Large amount medical insurance refers to the part that is reimbursed by commercial insurance above the upper limit of reimbursement of medical insurance
large amount insurance is a kind of fee that must be paid at the same time when you pay for medical insurance. As long as you pay for medical insurance, you must have this part of the money< The current medical insurance is divided into two parts, outpatient reimbursement and inpatient reimbursement, and the inpatient reimbursement part is called serious illness coordination. If you normally pay for medical insurance, you can enjoy the overall planning of serious illness.
1. Large amount medical insurance refers to the part that is reimbursed by commercial insurance above the upper limit of reimbursement of medical insurance
large amount insurance is a kind of fee that must be paid at the same time when you pay for medical insurance. As long as you pay for medical insurance, you must have this part of the money< The current medical insurance is divided into two parts, outpatient reimbursement and inpatient reimbursement, and the inpatient reimbursement part is called serious illness coordination. If you normally pay for medical insurance, you can enjoy the overall planning of serious illness.
7.
The steps of handling serious illness medical treatment are as follows:
1. The insured shall fill in the indivial application form of outpatient medical certificate for special diseases in plicate
2. Submit the completed application form, recent discharge records, outpatient medical records, relevant examination materials and a one inch photo to the unit
3. It was confirmed by the seal of the unit and reported to the Municipal Medical Insurance Center for approval. If the serious illness insurance benefits are directly settled by card in the local hospital, there is no need for additional reimbursement. In case of reimbursement in other places, local designated medical institutions should be selected for hospitalization; Within 3 months after discharge, they should go to the relevant departments for claim settlement with medical certificate, ID card (or household register), diagnosis certificate, discharge certificate, invoice and expense list (original)
extended data
coverage of serious illness insurance
20 kinds of diseases are included in rural serious illness insurance, and the reimbursement proportion is not less than 90%, including childhood leukemia, congenital heart disease, end-stage renal disease, breast cancer, cervical cancer, severe mental disease, drug-resistant tuberculosis, AIDS opportunistic infection, hemophilia, chronic myelogenous leukemia, cleft lip and palate, lung cancer, etc Esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction, colon cancer, rectal cancer
the policy of serious illness medical insurance adjusts the proportion of insurance premium financing to: a kind of supplementary insurance payment based on 4% of the sum of the total wages of employees and retirees in the previous year, with the actual number of insured employees of the employing unit as the base, and its benefits refer to the Interim Measures for supplementary medical insurance for employees directly under the provincial government
the other is based on the on-the-job employees of the employing unit and pays 10% of the total wages of the on-the-job employees, of which 4% is the pre tax fee and 6% is the after tax profit retention fee. The treatment they enjoy shall be implemented according to the Interim Measures for Medicaid of state civil servants directly under the provincial government
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9. In China, some families have high medical expenses because of illness, which brings great difficulties and pressure to families, and some families even return to poverty because of illness. China's implementation of serious illness medical insurance helps to alleviate this problem, then, what is the reimbursement ratio of serious illness medical insurance< Major illness medical insurance is actually a supplementary insurance of social insurance, which is funded by the government, collectives and indivials to commercial insurance institutions. Major illness medical insurance is a kind of medical insurance that pays for major illness to urban and rural residents< On August 30, 2012, six ministries and commissions, including the national development and Reform Commission, the Ministry of health, the Ministry of finance, the Ministry of human resources and social security, the Ministry of civil affairs, and the Insurance Regulatory Commission, issued the guidance on the development of serious illness insurance for urban and rural residents, which clearly targeted at the heavy burden of serious illness for urban residents with medical insurance and new rural cooperative medical insurance, Introce market mechanism, establish serious illness insurance system, rece the burden of serious illness of urban and rural residents, and the reimbursement rate of serious illness medical insurance shall not be less than 50%< (3) reimbursement standard of serious illness medical insurance
1. After being hospitalized e to illness (injury) and being reimbursed by new rural cooperative medical system, residents' medical insurance and serious illness insurance, 60% of the patients will be given assistance, and the maximum limit of one-time assistance is 20000 yuan
2. The key preferential care objects (excluding disabled soldiers of grade 1-6 and disabled soldiers of grade 7-10 with relapse of old injuries) were hospitalized e to illness. After reimbursement by the new rural cooperative medical system, residents' medical insurance, serious illness insurance and special assistance from the preferential care department, each person was given a maximum of 20000 yuan per year
3. The low-income families with difficulties and the families with major diseases who can't afford to stay in hospital e to illness will be given 20% assistance after reimbursement by the new rural cooperative medical system, residents' medical insurance and serious illness insurance, and the top line of one-time assistance is 10000 yuan
4. After the amount of hospitalization assistance reaches the top line, the out of pocket expenses should start at 10000 yuan, and the part above 10000 yuan should be given secondary assistance according to 30% of the proportion, with no more than 40000 yuan per person per year; After the amount of hospitalization assistance for other relief objects reaches the top line, the out of pocket expenses shall start from 10000 yuan, and the part above 10000 yuan shall be given secondary assistance according to the proportion of 20%, with no more than 20000 yuan per person per year
according to the above introction, part of the expenses can be reimbursed according to the regulations after participating in the medical insurance for major diseases. After reading the above introction, we have a certain understanding of the relevant legal knowledge of reimbursement proportion of medical insurance for major diseases
according to statistical data, the probability of a person suffering from a major disease in his life is 72%. Once a person suffers from a major disease and faces huge operation costs, the whole family may face extinction. Therefore, for the grassroots who have participated in the medical insurance, how much is the medical insurance compensation when they suffer from major diseases? For more information on the compensation rate for major diseases, please refer to the introction below
reimbursement proportion of medical insurance for major diseases:
according to the guidelines on medical insurance for major diseases issued by the state, urban and rural residents who participate in the national basic medical insurance can enjoy more than 50% of the reimbursement rate of indivial self paid part, plus the original reimbursement amount of basic medical insurance, as long as their condition is serious. It has really solved the problem of grassroots people's difficulty in seeing a doctor, and solved some stubborn diseases such as poverty caused by illness and returning to poverty e to illness
reimbursement scope of serious illness in medical insurance:
in the event of medical expenses exceeding the maximum payment limit of the basic medical co-ordination fund, the social insurance department will pay 85% of the expenses below 40000-40000 yuan, 90% of the expenses below 40000-80000 yuan, and 95% of the expenses above 80000 yuan. In each medical year, the maximum payment limit is RMB 150000.
1. After being hospitalized e to illness (injury) and being reimbursed by new rural cooperative medical system, residents' medical insurance and serious illness insurance, 60% of the patients will be given assistance, and the maximum limit of one-time assistance is 20000 yuan
2. The key preferential care objects (excluding disabled soldiers of grade 1-6 and disabled soldiers of grade 7-10 with relapse of old injuries) were hospitalized e to illness. After reimbursement by the new rural cooperative medical system, residents' medical insurance, serious illness insurance and special assistance from the preferential care department, each person was given a maximum of 20000 yuan per year
3. The low-income families with difficulties and the families with major diseases who can't afford to stay in hospital e to illness will be given 20% assistance after reimbursement by the new rural cooperative medical system, residents' medical insurance and serious illness insurance, and the top line of one-time assistance is 10000 yuan
4. After the amount of hospitalization assistance reaches the top line, the out of pocket expenses should start at 10000 yuan, and the part above 10000 yuan should be given secondary assistance according to 30% of the proportion, with no more than 40000 yuan per person per year; After the amount of hospitalization assistance for other relief objects reaches the top line, the out of pocket expenses shall start from 10000 yuan, and the part above 10000 yuan shall be given secondary assistance according to the proportion of 20%, with no more than 20000 yuan per person per year
according to the above introction, part of the expenses can be reimbursed according to the regulations after participating in the medical insurance for major diseases. After reading the above introction, we have a certain understanding of the relevant legal knowledge of reimbursement proportion of medical insurance for major diseases
according to statistical data, the probability of a person suffering from a major disease in his life is 72%. Once a person suffers from a major disease and faces huge operation costs, the whole family may face extinction. Therefore, for the grassroots who have participated in the medical insurance, how much is the medical insurance compensation when they suffer from major diseases? For more information on the compensation rate for major diseases, please refer to the introction below
reimbursement proportion of medical insurance for major diseases:
according to the guidelines on medical insurance for major diseases issued by the state, urban and rural residents who participate in the national basic medical insurance can enjoy more than 50% of the reimbursement rate of indivial self paid part, plus the original reimbursement amount of basic medical insurance, as long as their condition is serious. It has really solved the problem of grassroots people's difficulty in seeing a doctor, and solved some stubborn diseases such as poverty caused by illness and returning to poverty e to illness
reimbursement scope of serious illness in medical insurance:
in the event of medical expenses exceeding the maximum payment limit of the basic medical co-ordination fund, the social insurance department will pay 85% of the expenses below 40000-40000 yuan, 90% of the expenses below 40000-80000 yuan, and 95% of the expenses above 80000 yuan. In each medical year, the maximum payment limit is RMB 150000.
10. If the reimbursement amount of NCMS exceeds the limit, it cannot be reimbursed across years
"new rural cooperative medical system", full name of new rural cooperative medical system, refers to the mutual medical assistance system for farmers, which is organized, guided and supported by the government, participated by farmers voluntarily, financed by indivials, collectives and the government in many ways, and based on the overall planning of serious diseases
the new rural cooperative medical system is a mutual aid medical security system created by Chinese farmers, which plays an important role in ensuring farmers to obtain basic health services, alleviating poverty caused by illness and returning to poverty e to illness. The reimbursement scope of NCMS includes outpatient compensation, hospitalization compensation and serious illness compensation
the reimbursement scope of the new rural cooperative medical system is as follows:
the part (i.e. effective medical expenses) that the medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses, nursing expenses, etc. of the participants who are hospitalized in the designated hospital e to illness ring the overall planning period are in line with the reimbursement scope of medical insurance for urban employees
the new rural cooperative medical fund has set the starting payment standard and the maximum payment limit. The hospitalization expenses below the standard paid by the hospital every year shall be paid by the indivial. For those who reach the minimum payment standard in the same overall planning period, the hospitalization expenses incurred by two or more times of hospitalization can be reimbursed accumulatively. If the hospitalization expenses exceed the starting payment standard, it shall be calculated by sections and reimbursed accumulatively. There is a maximum amount of reimbursement for each person every year<
the following situations are not included in the reimbursement scope of the new rural cooperative medical system:
(1) outpatient medical expenses of non designated hospitals in the region (except for the outpatient treatment expenses of special diseases), medical expenses incurred by non-compliance with regulations and self purchase of drugs< (2) expenses for family planning measures and medical expenses in violation of family planning policies< (3) dental inlay, orthodontics, optometry, hearing aids, artificial organs, cosmetic treatment, plastic surgery and orthopedic surgery, rehabilitation medical treatment (such as Qigong, massage, massage, physiotherapy, magnetic therapy, etc.), as well as various accompanying expenses, transportation expenses, visiting expenses, other miscellaneous expenses ring hospitalization, etc< (4) in the case of third-party liability, medical expenses arising from personal injury shall be borne by the third party according to law, such as traffic accident, medical accident, instrial injury, etc< (5) medical expenses arising from the injury caused by the illegal acts such as suicide, self mutilation, taking drugs, taking drugs, fighting, etc. and the intentional acts of their family members< (6) medical expenses incurred ring the period of going abroad or staying in Hong Kong, Macao or Taiwan< (7) drugs and items not to be reimbursed according to the medical insurance system for urban employees< (8) other non reimbursable expenses determined by the district medical management committee.
"new rural cooperative medical system", full name of new rural cooperative medical system, refers to the mutual medical assistance system for farmers, which is organized, guided and supported by the government, participated by farmers voluntarily, financed by indivials, collectives and the government in many ways, and based on the overall planning of serious diseases
the new rural cooperative medical system is a mutual aid medical security system created by Chinese farmers, which plays an important role in ensuring farmers to obtain basic health services, alleviating poverty caused by illness and returning to poverty e to illness. The reimbursement scope of NCMS includes outpatient compensation, hospitalization compensation and serious illness compensation
the reimbursement scope of the new rural cooperative medical system is as follows:
the part (i.e. effective medical expenses) that the medical expenses, examination expenses, laboratory expenses, operation expenses, treatment expenses, nursing expenses, etc. of the participants who are hospitalized in the designated hospital e to illness ring the overall planning period are in line with the reimbursement scope of medical insurance for urban employees
the new rural cooperative medical fund has set the starting payment standard and the maximum payment limit. The hospitalization expenses below the standard paid by the hospital every year shall be paid by the indivial. For those who reach the minimum payment standard in the same overall planning period, the hospitalization expenses incurred by two or more times of hospitalization can be reimbursed accumulatively. If the hospitalization expenses exceed the starting payment standard, it shall be calculated by sections and reimbursed accumulatively. There is a maximum amount of reimbursement for each person every year<
the following situations are not included in the reimbursement scope of the new rural cooperative medical system:
(1) outpatient medical expenses of non designated hospitals in the region (except for the outpatient treatment expenses of special diseases), medical expenses incurred by non-compliance with regulations and self purchase of drugs< (2) expenses for family planning measures and medical expenses in violation of family planning policies< (3) dental inlay, orthodontics, optometry, hearing aids, artificial organs, cosmetic treatment, plastic surgery and orthopedic surgery, rehabilitation medical treatment (such as Qigong, massage, massage, physiotherapy, magnetic therapy, etc.), as well as various accompanying expenses, transportation expenses, visiting expenses, other miscellaneous expenses ring hospitalization, etc< (4) in the case of third-party liability, medical expenses arising from personal injury shall be borne by the third party according to law, such as traffic accident, medical accident, instrial injury, etc< (5) medical expenses arising from the injury caused by the illegal acts such as suicide, self mutilation, taking drugs, taking drugs, fighting, etc. and the intentional acts of their family members< (6) medical expenses incurred ring the period of going abroad or staying in Hong Kong, Macao or Taiwan< (7) drugs and items not to be reimbursed according to the medical insurance system for urban employees< (8) other non reimbursable expenses determined by the district medical management committee.
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