First-class insured: any designated medical institution in this city for medical treatment.
Second-class insured persons: outpatients seek medical treatment in the binding community health center, inpatient departments seek medical treatment in any designated medical institutions in the city, and outpatients seek medical treatment in designated medical institutions for serious illness.
Third-level insured persons: outpatients seek medical treatment in the binding social health center, and inpatients and outpatients seek medical treatment in prescribed medical institutions for serious illness.
2. General outpatient treatment
A type of insurance: personal account is used to pay the medical expenses within the scope of the insured's general outpatient medical insurance catalogue. Community health center basic medical expenses personal account to pay 70%, the overall fund to pay 30% in accordance with the provisions.
Second Insured/Third Insured:
Belong to class A drugs and class B drugs, respectively, by the community outpatient fund according to the proportion of 80% and 60% payment;
90% of the single diagnosis and treatment or medical materials belonging to the medical insurance catalogue shall be paid by the community outpatient co-ordination fund, but the maximum payment shall not exceed 120 yuan.
The total outpatient medical expenses paid by the community outpatient co-ordination fund to each second-grade and third-grade insured within a medical insurance year shall not exceed 1000 yuan.
3. Personal account family * * *
A class of insured persons: the accumulated amount of personal accounts exceeds 5% of the average salary of employees in this city in the previous year, and the excess can be purchased in designated pharmacies of over-the-counter drugs within the scope of medical insurance catalogue; When visiting a designated medical institution, you can pay the basic medical expenses and local supplementary medical expenses paid by yourself and your spouse and immediate family members who participate in the basic medical insurance in this Municipality; It can cover the health check-up and vaccination expenses for me, my spouse and immediate family members to participate in the basic medical insurance in this city.
Secondary Insured/Tertiary Insured: None.
4. Personal account is not enough to pay.
First-class insured person: First-class insured person has been insured continuously for one year, and the average salary of supermarket employees is 5% of the basic outpatient medical expenses and supplementary medical expenses paid by himself in the same medical insurance year, and 70% of the excess is paid by the overall fund according to regulations (80% for those over 70 years old).
Secondary Insured/Tertiary Insured: None.
5, outpatient large equipment inspection and treatment costs
First-class insured: 80% shall be paid by the overall fund as required.
Second-level insured/third-level insured: the highest unit price of general medical treatment items shall not exceed 120 yuan.
6, general outpatient blood transfusion costs
First-class insured: 90% shall be paid by the overall fund as required.
Second-level insured/third-level insured: 70% shall be paid by the overall fund as required.
7, outpatient treatment of serious illness
First-class insured/second-class insured/third-class insured: 60%-90% will be paid by the overall fund according to the continuous insurance years.
8. Medical subsidies
First-class insurance: one-time 500 yuan at retirement, 20 yuan per person per month (40 yuan per person at the age of 70).
Secondary Insured/Tertiary Insured: None.
9. Hospitalization
First-class insured: 95% or 90% of the basic medical expenses incurred in hospitalization and supplementary medical expenses above the deductible line shall be paid according to the regulations.
Second Insured/Third Insured:
(1) You can be hospitalized in the settlement hospital of the binding social health center, or you can be referred to the designated hospital by the settlement hospital. The reimbursement ratio of basic medical expenses and local supplementary medical expenses above the hospitalization deductible line is:
Level I hospital: 85%
Level II hospital: 80%
Tertiary hospitals: 75%
(2) Those who have not been referred to a hospital other than the settlement hospital shall be paid 90% of the hospitalization payment standard of the hospital (that is, the payment standard in the above 1).
Seek medical treatment outside the city
First-class insured: general outpatient expenses, serious illness outpatient expenses and hospitalization expenses can be reimbursed according to regulations.
Second-class insured/third-class insured: general outpatient expenses will not be reimbursed; In accordance with the provisions of the serious illness outpatient expenses and hospitalization expenses can be reimbursed according to the provisions.