Medical insurance is divided into three grades: . Basic medical first grade, basic medical second grade and basic medical third grade, its payment, treatment and adapt to the population are different.
I. Principles of medical treatment
1, the first grade of participants: the city of any certain point of medical institutions.
2. Participants in the second class: outpatient treatment in the bound community health centers, inpatient treatment in any designated medical institutions in the city, and outpatient treatment of serious illnesses in the prescribed medical institutions.
3. Participants in the third tier: outpatient treatment in the bound community health centers, inpatient treatment and outpatient treatment for major diseases in the prescribed medical institutions.
2. Contributions?
1, basic medical first class (unit 6% + individual 2%) + local supplementary medical (unit 0.2%) + maternity medical (unit 0.5%), the contribution base for the employee's actual contribution to the wage (minimum of 3,131 yuan), the total contribution of 272 yuan;
2, basic medical second class (unit 0.5% + individual 0.2%) + local supplementary medical (unit 0.1%) + maternity medical (unit 0.2%) contribution base for the previous year's average monthly salary of on-the-job workers (now 5218), the total payment of 52;
3, the basic medical third class (unit 0.4% + individual 0.1%) + local supplemental medical (unit 0.05%), the contribution base for the previous year's average monthly salary of on-the-job workers (now 5218), the total payment of 29 yuan The total payment is 29 yuan.
Three, general outpatient treatment
1, first class participation: individual account for the payment of participants in the general outpatient health insurance catalog range of medical expenses. 70% of the basic medical expenses of the health center are paid by the individual account and 30% are paid by the integrated fund according to the regulations.
2. Second-grade participants/third-grade participants:
(1) For drugs belonging to Class A and Class B, 80% and 60% respectively will be paid by the community outpatient coordinated fund;
(2) For single diagnosis and treatment or medical materials belonging to the medical insurance catalog, 90% will be paid by the community outpatient coordinated fund, but the maximum amount of payment will not be more than 120 yuan;
(3) The total amount of outpatient medical expenses paid by the Community Outpatient Coordination Fund to each participant in the second or third class shall not exceed RMB 1,000 in a medical insurance year.
Four, individual account family **** relief
1, the first tranche of participants: individual account accumulation amount exceeds 5% of the city's average salary of on-the-job workers in the previous year, the excess can be to the designated pharmacy to buy medical insurance catalog range of over-the-counter medicines; can be for themselves and their spouses and immediate family members who have participated in the city's basic medical insurance payment.
The basic medical expenses and local supplementary medical expenses paid out of pocket during the visit to the designated medical institutions; and health checkups and preventive inoculation expenses for the person and his/her spouse and immediate family members who have participated in the city's basic medical insurance.
2, second-class participants/third-class participants: no, to the pharmacy to buy drugs can not swipe the social security card.
V. Individual account underpayment
1, the first tranche of participants: they have been continuously insured for one year, in the same medical insurance year, out-of-pocket basic outpatient medical expenses and medical expenses of the local subsidies supermarkets in the average salary of the workers on the job of 5%, the excess portion of the integrated fund by the provisions of the 70% (over 70 years of age and above to pay 80%).
2. Second-grade participants/third-grade participants: none
6. Expenses incurred for outpatient large equipment examination and treatment
1. First-grade participants: 80% of the expenses will be paid by the integrated fund in accordance with the regulations.
2. Participants in the second/third tier: the unit price of general diagnostic and treatment items will be paid at a maximum of 120 yuan.
VII. General Outpatient Blood Transfusion Costs
1. 1st tier participants: 90% of the cost will be paid by the integrated fund according to the regulations.
2. Participants in the second/third tier: 70% will be paid by the integrated fund according to the regulations.
VIII. Outpatient Treatment for Major Diseases
First-tier insured/second-tier insured/third-tier insured: 60%-90% of the outpatient treatment will be paid by the fund according to the length of time of continuous participation.
IX. Hospitalization treatment
1. First-tier participants: 95% or 90% of basic medical expenses and local supplementary medical expenses incurred in hospitalization will be paid above the starting line according to regulations.
2. Second-tier participants/third-tier participants:
(1) If you can be hospitalized in the settlement hospitals of the bounded social welfare centers or referred to the prescribed hospitals by the settlement hospitals, the reimbursement ratio for the part of the basic medical expenses and local supplementary medical expenses incurred above the hospitalization thresholds shall be as follows: first-tier hospitals: 85%; second-tier hospitals: 80%; and third-tier hospitals: 75%
.(2) In case of hospitalization in a prescribed hospital other than the billing hospital without referral, 90% of the hospitalization payment standard of the attending hospital (i.e., the payment standard in Article 1 above) will be paid.
X. Treatment for medical treatment outside the city
1. First-tier participants: general outpatient expenses, outpatient expenses for major illnesses, and inpatient hospitalization expenses can be reimbursed according to the regulations.
2. Participants in the second/third class: general outpatient expenses are not reimbursed; outpatient expenses for major illnesses and hospitalization expenses are reimbursed in accordance with the regulations.
Note: Policies are subject to change from time to time, please refer to the latest policy
.