1. When the medical expenses exceed the maximum payment limit of the basic medical pooling fund, 85% of the expenses below RMB 0-40,000, 90% below RMB 40,000-80,000 and 95% above RMB 80,000 will be reimbursed by the social insurance department. The maximum payment limit for each medical year is 6.5438 yuan +0.5 million yuan. 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%.
2. Although there is no clear disease type in medical insurance for serious illness, more than 20 major diseases of the new rural cooperative medical system have reference significance, including childhood leukemia, congenital heart disease, end-stage renal disease, breast cancer, cervical cancer, severe mental illness, drug-resistant tuberculosis, AIDS opportunistic infection, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, cerebral infarction and so on. Shandong Province has clearly included the first batch of 20 diseases into the scope of medical insurance for serious illness.
In order to ensure the basic medical care for urban workers and make rational use of medical resources, according to the relevant provisions of the state, combined with the actual situation of this province, the Regulations on the Basic Medical Insurance for Urban Workers in People's Republic of China (PRC) are formulated.
People's Republic of China (PRC) social insurance law
Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, industrial injury insurance, unemployment insurance and maternity insurance, so as to guarantee citizens' right to receive material assistance from the state and society in accordance with the law in case of old age, illness, industrial injury, unemployment and maternity.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.