Medical assistance for major illnesses refers to a new type of medical assistance system that relies on the settlement platforms of urban residents' (employees') basic medical insurance and the new rural cooperative medical care, with stable financial input, service platforms*** use, information resources*** enjoyment, synchronization of settlements and payments, standardized management and operation, and obvious relief effects, and that is able to provide fast services for the needy, covering both urban and rural areas in a scientific and standardized manner.
In order to ensure that the large medical expenses subsidy insurance premium balance, the "Notice" said, according to the operation of the large medical expenses subsidy insurance for urban workers, the large medical expenses subsidy insurance premium standard is also adjusted from 96 yuan per person per year to 132 yuan per person per year, of which the employing unit to pay 66 yuan, the individual to pay 66 yuan.
Flexible employment participants, bankruptcy, closure and cancellation of the employing unit retirees all paid by individuals.
Expanded Information:
After a participant's hospitalization medical fee exceeds the maximum payment limit of the basic medical insurance co-ordination fund, the unit or hospital fills in the "Large Medical Co-ordination Fee Declaration Form" and declares it to the Municipal Medical Insurance Bureau.
In the case of medical treatment, in addition to personal out-of-pocket expenses, large medical expenses are settled between the hospital and the Municipal Medical Insurance Bureau; in the case of transferring to another place for medical treatment, the unit will reimburse the Municipal Medical Insurance Bureau with the "transferring to another place for medical treatment declaration form", hospitalization expense receipts, hospitalization summary, and the list of expenses.
The reimbursement rate for large medical expenses is 90% (80% for those who are transferred out for medical treatment), and the maximum payment limit of the large medical insurance fund is 125,000 yuan (excluding the ?25,000 yuan paid by the Basic Medical Insurance Co-ordination Fund) within a 12-month period.
Baidu Encyclopedia - Large Medical Insurance