Serious illness cancer insurance is to reimburse the high medical expenses incurred by urban and rural residents due to serious illness cancer, with the aim of solving the problem of "poverty caused by illness and returning to poverty due to illness" which is strongly reflected by the masses. It was learned from Wuxi Medical Insurance Bureau that since June 5438+1 October1this year, the deductible line of Wuxi medical insurance for severe cancer has been adjusted from the original 1.7 million yuan to 2 1 10,000 yuan, and the reimbursement amount is not capped. For the strategy of medical insurance reimbursement, I just sorted out the relevant contents, hoping to help you: the national social security medical insurance application reimbursement process in 2020!

Wuxi's current policy on critical illness cancer insurance was promulgated on 20 13. According to the guidance of the national and provincial people's and social welfare departments on serious illness cancer insurance, the deductible line of serious illness cancer insurance is set at 50% of the annual per capita disposable income of local urban residents in the previous year. According to the calculation of per capita disposable income, starting from 20 15, the deductible line of Wuxi's critical illness cancer insurance was adjusted from the original170,000 yuan to 2 10/0,000 yuan, and the reimbursement amount was not capped.

The coverage of Wuxi's serious illness cancer insurance covers the insured's compliance medical expenses incurred in the hospitalization and outpatient treatment of special diseases during the year. After compensation by residents' basic medical insurance, urban workers' basic medical insurance, employees' supplementary medical insurance and civil servants' Medicaid, the personal burden exceeded 50% of the annual per capita disposable income of urban residents in the previous year (1.7 million yuan).

However, not all diseases can be reimbursed by critical illness cancer insurance. "Generally speaking, compliant medical expenses that meet the three categories can be reimbursed." Some cases that can't be reported by serious illness cancer insurance, such as outpatient and emergency outpatient; Without the approval of the medical insurance department, being hospitalized, giving birth, family planning and being injured at work in non-designated medical institutions in this Municipality; Buy medicine at retail pharmacies; The use of drugs, organ sources and various organ and tissue sources beyond the scope stipulated in People's Republic of China (PRC) Pharmacopoeia and China Pharmacopoeia; Exceeding the treatment standards stipulated by the national, provincial and municipal price departments and urban basic medical insurance.

Bao Ge reminds: Since 20 15, Wuxi has implemented a new threshold for critical illness cancer insurance, which has been adjusted from the original 1.7 million yuan to 2 1 10,000 yuan, and the reimbursement amount is not capped. The coverage of Wuxi's serious illness cancer insurance is to ensure the insured's compliance with medical expenses incurred in the hospitalization and outpatient treatment of special diseases within one year. After compensation by residents' basic medical insurance, the personal burden exceeded 50% of the annual per capita disposable income of urban residents in the previous year (6.5438+0.7 million yuan).