1. Medical expenses in medical insurance: reimbursement of outpatient and inpatient medical expenses paid by oneself in the medical insurance catalogue, no compensation below the deductible line of critical illness medical insurance in that year, 80% of healthy people, 40% of patients with previous diseases, and the insured amount is 6,543,800+000.
2. Medical expenses outside medical insurance: reimbursement of hospitalization medical expenses occurred in designated medical institutions and out of the medical insurance catalogue, accounting for 70% of the deductible line of 20,000 for healthy people and 35% of the deductible line of 40,000 for people with previous diseases, with the insured amount of 6,543.8+0,000.
3, 100 kinds of high-priced special drugs at home and abroad.
Social medical insurance is a social insurance system established by the state and society according to certain laws and regulations to provide basic medical needs for workers within the scope of protection. It is undertaken by the government and implemented and managed by economic, administrative and legal means.
Social medical insurance consists of basic medical insurance and large medical assistance, enterprise supplementary medical insurance and individual supplementary medical insurance.
individual account
Account establishment
The social medical insurance agency shall establish a personal account of basic medical insurance for each insured person, and take my ID number as the lifelong medical insurance number. The funds in the employee's personal account of basic medical insurance are owned by individuals and used for medical consumption. Overexpenditure is not covered, balance is accumulated, and cash is not withdrawn. When an employee dies, his personal account is cancelled and the balance is inherited according to regulations.
Settlement and release
The employing unit shall handle the personal medical account settlement card for employees while participating in the basic medical insurance. Within 30 days from the date of participating in medical insurance, the employer shall apply to the social medical insurance agency and provide relevant information. After receiving the application from the employer to establish a household for employees, the social medical insurance agency will carefully review the relevant materials, establish a personal account for employees within 15 days, and issue a personal account settlement card. Inject funds into the employee's personal medical account in time, and bear interest according to relevant regulations. Retirees placed in different places may not issue cards temporarily.
Insured persons can purchase drugs at any designated medical institutions and pharmacies in the overall planning area with personal medical account cards. When the funds in the personal medical account are insufficient, they will be paid in cash.
Transfer inheritance
When the insured person is transferred out, the funds in the personal medical account will be transferred together. If you can't transfer, you can return the balance of your personal account to me and cancel your personal account at the same time.
If the insured dies, the balance of the personal account can be inherited by his legal heir.
Report the loss and reissue
The insured shall properly keep the personal account card, and if it is damaged, it needs to be replaced with a new card, and the expenses shall be borne by the individual. If the personal account card is lost, it should be reported to the medical insurance agency or designated unit with relevant documents in time, and the medical insurance agency should immediately seal the account. If you can't find it within 30 days, you should apply for a new card at your own expense. The medical expenses incurred during the loss reporting period shall be paid in cash by the employee's personal account. If the personal account card is fraudulently used before reporting the loss, the insured shall bear the loss.