Legal subjectivity:

The proportion of reimbursement for serious illness medical insurance in Guangzhou is clearly stipulated in our laws. The sources of large-scale medical mutual aid funds are composed of three parties: the state, units and individuals. On the basis of participating in basic medical insurance, the employer pays 1% of the total wages, and employees and retirees pay 3 yuan money each month to solve the problems of outpatient, emergency and hospitalization. When the mutual funds for large medical expenses are insufficient to pay, the finance will give appropriate subsidies. According to the bearing capacity of the raised funds, the expenses are reimbursed according to the following standards: 51% for the part of outpatient and emergency medical treatment that costs more than 2,111 yuan in the current year; In order to take care of retirees, the minimum payment standard for reimbursement will be reduced to 1,511 yuan, and the reimbursement ratio will be increased to 61%. Among them, the reimbursement ratio is 71% for those over 71 years old, and the maximum amount of reimbursement can be 21,111 yuan in one year. 71% of the medical expenses above the capping line are reimbursed by the large medical mutual aid fund, and the accumulated maximum reimbursement amount in one year is RMB 1,111,111. Legal objectivity:

For some serious diseases that are particularly expensive, 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 51%. Six departments, including the National Development and Reform Commission, the Ministry of Health, the Ministry of Finance, the Ministry of Human Resources and Social Security, the Ministry of Civil Affairs, and the Insurance Regulatory Commission, issued the Guiding Opinions on Developing Serious Illness Insurance for Urban and Rural Residents, in order to avoid poverty caused by illness and returning to poverty due to illness. The main points of the new policy of serious illness insurance for urban and rural residents: First, the insured persons of urban residents' medical insurance and the new rural cooperative medical system are guaranteed. Second, the source of funds is drawn from the urban residents' medical insurance fund and the new rural cooperative medical system fund, so as not to increase the burden of individual contributions. Third, the standard of protection is that the high annual medical expenses of patients exceed the annual per capita disposable income of urban residents and the annual per capita net income of rural residents in the previous year, and the specific amount is determined by local governments. Fourth, the actual payment ratio of the level of insurance is not less than 51%; In principle, the higher the medical expenses, the higher the payment ratio. V. Mode of Undertaking The government departments determine policies such as reimbursement, and select commercial insurance institutions to undertake through bidding. It is understood that at present, there are more than 51 diseases in China that may cause some families to become poor or return to poverty due to illness. The National Development and Reform Commission (NDRC) said yesterday that the purpose of carrying out serious illness insurance to reimburse the high medical expenses incurred by urban and rural residents due to serious illness is to avoid poverty caused by illness and returning to poverty due to illness. The object of serious illness insurance is the insured of urban residents' medical insurance and the new rural cooperative medical system, and the funds needed are drawn from the urban residents' medical insurance fund and the new rural cooperative medical system fund, so as not to increase the individual payment burden of the masses. According to the calculation, the annual per capita disposable income of urban residents or the annual per capita net income of farmers can be used as the standard of catastrophic medical expenditure of local families. When the medical expenses borne by the insured patients exceed this standard, it is likely that the family will be in financial difficulties. Serious illness insurance will reimburse the compliance medical expenses borne by this small group of people on the basis that the basic medical insurance has been reimbursed, and the actual reimbursement ratio is required to be no less than 51%. Compliance medical expenses here are not limited to the basic medical insurance policy, but in order to avoid waste and excessive burden, items that are not necessary for basic treatment are not included in the scope of reimbursement. Commercial institutions undertake serious illness insurance. According to the document, the fund for serious illness insurance comes from the balance of the original medical insurance fund, and it is handed over to commercial insurance institutions for management, and the way of purchasing serious illness insurance from commercial insurance institutions is adopted. Commercial insurance institutions undertaking serious illness insurance must operate special health insurance business in China for more than 5 years; Have a perfect service network and strong professional ability of medical insurance; Equipped with full-time service personnel with medical and other professional backgrounds; It can realize separate accounting of serious illness insurance business and so on. At the same time, it is necessary to reasonably control the profitability of commercial insurance institutions, and provide "one-stop" instant settlement services to ensure that people can enjoy serious illness insurance benefits conveniently and in time.