1. Responsibility in medical insurance (self-payment plus self-payment two): 80% of the out-of-pocket expenses incurred by the insured in the general department of the medical institution designated by medical insurance can be reimbursed after deducting the deductible (the lowest compensation in critical illness insurance in that year), but 40% can be reimbursed if it is a specific group of people who have been sick in the past, with the insured amount of 6,543,800 yuan.
2. Out-of-liability (self-payment) of medical insurance: 70% of the necessary and reasonable out-of-hospital medical expenses incurred by the insured in the general inpatient department of a hospital designated by the basic medical insurance (654.38+0.5 million healthy people and 20,000 people with specific past diseases) can be reimbursed after deducting the deductible. However, if it is a specific population with past diseases, it will be reimbursed at 35%, with the insured amount 1 10,000 (the annual reimbursement limit for a single drug is 300,000; For a single implant or consumables, the annual reimbursement limit is 654.38+ 10,000).
3. Special drug liability (40 kinds of domestic special drugs +60 kinds of overseas special drugs): 40 kinds of domestic special drugs purchased by the insured in designated medical institutions, diagnosed and prescribed by specialists, and 60 kinds of overseas special drugs treated and prescribed in designated medical institutions in Lecheng, Boao, Hainan, can be reimbursed at 60%, but the domestic special drugs can be reimbursed at 30%.
It should be noted that before the effective date of the policy, the insured has suffered from the following five diseases, belonging to a specific group with previous diseases:
1. Malignant tumor (including leukemia, lymphoma and carcinoma in situ): refers to diseases in which malignant cells grow and spread uncontrollably, infiltrate and destroy surrounding normal tissues, and can spread to other parts of the body through blood vessels, lymphatic vessels and body cavities. According to the results of pathological examination, the clinical diagnosis belongs to the category of malignant tumors in the International Statistical Classification of Diseases and Related Health Problems (ICD- 10) of the World Health Organization, and the tumor morphological codes in the oncology album of the third edition of the International Classification of Diseases (ICD-O-3) belong to categories 3, 6 and 9 (malignant tumors).
(2) Liver and kidney diseases: ① Renal insufficiency: chronic renal insufficiency and chronic renal failure. ② Hepatic insufficiency: chronic hepatic insufficiency, liver cirrhosis and chronic liver failure.
(3) Cardiovascular and cerebrovascular diseases and glycolipid metabolic diseases: ① Heart diseases: coronary heart disease, myocardial infarction, cardiac rupture, cardiac stroke, chronic cardiac insufficiency and chronic heart failure. ② Cerebrovascular diseases: cerebral embolism, cerebral infarction, cerebral hemorrhage and stroke. ③ Hypertension: Grade III hypertension. ④ Diabetes: Diabetes with complications.
(4) Pulmonary diseases: ① Chronic obstructive pulmonary disease ② Chronic respiratory failure.
(5) Other diseases: ① Systemic lupus erythematosus; ② Aplastic anemia; ③ Ulcerative colitis.