How to calculate the medical insurance outpatient treatment
Participants in the comprehensive medical insurance has a personal account, which is calculated as follows: basic medical insurance premiums in the part of the individual's contribution (that is, 2% of the paid wages) are all counted in the personal account; basic medical insurance premiums in the employer or the municipal social insurance agency to contribute to the individual account; the basic medical insurance premiums in the employer or the municipal social insurance agency to contribute to the individual account. or municipal social insurance agency to pay the part of 35 years of age (not including 35 years of age) in the following in-service participants, 30% into the individual account; 35 years of age more than 45 years of age (not including 45 years of age) in the following in-service participants, 40% into the individual account; 45 years of age or older in the in-service participants, 50% into the individual account; 60% of the retirees into the individual account. Comprehensive medical insurance participants outpatient basic medical expenses and outpatient use of local supplementary medical insurance drug list of drugs, diagnostic and treatment items, paid by the individual account; individual account is not enough to pay for its medical insurance year (July 1 to the next year, June 30) more than the city's last year, more than 10 percent of the average annual salary of urban workers in the outpatient basic medical costs, by the basic health insurance The basic medical insurance fund will pay 70% of the outpatient medical expenses and the individual will pay 30% out-of-pocket. If the amount accumulated in the individual account reaches two months of the average monthly salary of urban workers in the previous year, the excess can be used to pay for the out-of-pocket basic medical expenses at designated medical institutions, local supplementary medical expenses, or to purchase non-prescription medicines within the scope of the basic medical insurance medicine list and the local supplementary medical insurance medicine list at designated retail pharmacies. If a participant leaves the city, the balance of the individual account will be transferred to the social insurance organization in the place where the participant's household is located; if there is no corresponding organization in the local area, the balance will be returned to the participant in a lump sum. If the participant dies, the balance of the individual account will be paid to the heir; if there is no heir, it will be transferred to the basic medical insurance fund. When a participant of comprehensive medical insurance has an outpatient medical examination or treatment with large-scale medical equipment due to the need of his/her condition and approved by the municipal social insurance institution or its authorized medical institution, the cost of such examination or treatment will be paid by the basic medical insurance fund at a rate of 80%, and the individual will have to pay 20% out of his/her own pocket. The outpatient medical expenses of inpatient medical insurance participants are generally self-care, but outpatient dialysis for chronic renal failure, outpatient anti-rejection drugs after organ transplantation, outpatient chemotherapy for malignant tumors, interventional therapy, radiotherapy, or nuclide therapy, and the same as the comprehensive medical insurance participants, approved by the municipal social insurance institutions, the basic medical expenses are paid by the basic medical insurance fund of 90%, and the individual out-of-pocket expenses of 10%.