According to Kunshan City’s medical insurance management regulations, insured employees, within the scope of the policy, require uremic dialysis, use of rejection drugs after organ transplantation, and radiotherapy and chemotherapy for malignant tumors, with a cumulative cost of less than 40,000 yuan. Part of it can be settled at a rate of 90%. The portion between 40,000 yuan and 100,000 yuan can be settled at a rate of 95%. If the insured person's medical expenses for specific items of hospitalization and outpatient services that meet the regulations in the settlement year exceed 100,000 yuan in total, 95% will be paid by the critical illness insurance, and the remaining 5% will be paid by the individual.
The above is the reimbursement ratio for insured employees. If you are a participant in urban and rural medical insurance, some of the above treatment expenses will still be paid at a rate of 90% for the part within 100,000 yuan. of.
Legal basis:
"Social Insurance Law of the People's Republic of China"
Article 2 The state establishes basic pension insurance, basic medical insurance, and work-related injury insurance , unemployment insurance, maternity insurance and other social insurance systems to protect citizens’ rights to obtain material assistance from the state and society in accordance with the law in the event of old age, illness, work injury, unemployment, childbirth, etc.
Article 26 The treatment standards of the basic medical insurance for employees, the new rural cooperative medical insurance and the basic medical insurance for urban residents shall be implemented in accordance with national regulations.
Article 28 Medical expenses that comply with the basic medical insurance drug catalog, diagnosis and treatment items, medical service facility standards, and emergency and rescue expenses shall be paid from the basic medical insurance fund in accordance with national regulations.