1. Insurance premium for specific hospitalization medical expenses: including the specific hospitalization medical expenses reasonably necessary for the insured after hospitalization in the general inpatient department of the hospital designated by the second-level and above medical insurance due to illness or accident. After deducting the annual deductible, the annual deductible is 20,000, 70% for non-previous patients and 50% for previous patients, and the insurance amount is 6,543,800+0,000. The cost of materials for a single hospitalization operation is 200 thousand, and PET-CT is limited to once a year;
2. Insurance premium of some high-priced drugs in China: including the expenses for the insured to purchase and use the drugs listed in the Catalogue of Some High-priced Drugs in China in the outpatient department of Shanghai second-class hospitals or pharmacies with drug sales qualification after being registered in Shanghai hospitals and diagnosed as specific diseases by designated specialists. Non-previous patients can be reimbursed 70% of the expenses. People with past diseases can be reimbursed 30%, and the insured amount is 654.38+0 million;
3. Proton heavy ion medical insurance: including the reasonable and necessary positioning and radiotherapy planning expenses of the insured for proton heavy ion therapy in a medical institution with proton heavy ion therapy qualification in Shanghai due to malignant tumor, as well as the expenses for implementing proton heavy ion radiotherapy (excluding bed fees, chemotherapy fees and other expenses). Non-previous patients can be reimbursed 70%, and former patients can be reimbursed 30%.
4. Insurance premium for overseas special drugs: including the expenses for the insured to purchase and use the overseas special drugs listed in the outpatient or inpatient departments of Hainan Boao Super Hospital, Boao International Hospital, Boao Evergrande International Hospital and Hainan Hospital affiliated to Shanghai Jiaotong University School of Medicine (Hainan Boao Research Hospital) after registration, and to appoint specialists to diagnose specific diseases, write outpatient medical records and prescribe them. Patients with non-past diseases can be reimbursed 70%, and patients with past diseases can be reimbursed.
5.CAR-T drug treatment expense insurance premium: It includes the expenses of the insured who is diagnosed as meeting CAR-T requirements by designated specialists, treated in CAR-T designated hospitals, and purchased and used drugs for CAR-T indications and indications in CAR-T designated hospitals, which can be reimbursed by 65,438+000% with the insured amount of 500,000.
Legal basis:
People's Republic of China (PRC) social insurance law
second
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 when they are old, sick, injured, unemployed and have children.
People's Republic of China (PRC) social insurance law
essay
The social insurance system adheres to the principles of wide coverage, basic protection, multi-level and sustainability, and the level of social insurance should be compatible with the level of economic and social development.