1. Outpatient and emergency medical expenses;
2. The cost of purchasing drugs at designated retail pharmacies;
3 basic medical insurance fund Qifubiaozhun below the medical expenses;
4 more than the basic medical insurance fund Qifubiaozhun, medical expenses shall be borne by individuals in proportion.
The insufficient part of personal account shall be paid by myself.
Two, the overall fund medical insurance fund payment according to the following provisions.
1. Hospitalization expenses;
2 emergency rescue observation and hospitalization income, medical expenses within 7 days before hospitalization observation;
3. Outpatient medical expenses for taking anti-rejection drugs after radiotherapy and chemotherapy, renal dialysis and renal transplantation for malignant tumors.
Three, the basic medical insurance fund payment Qifubiaozhun, the highest capping line.
The qifubiaozhun for the payment of the basic medical insurance co-ordination fund is determined by about 10% of the average wage of employees in this city in the previous year. For medical expenses incurred by an individual in the second and later hospitalization within a year, the Qifubiaozhun is determined at about 5% of the average salary of employees in this city in the previous year (2006 1 year 6300 yuan).
Enjoy the city's urban residents minimum living guarantee of the insured, the basic medical insurance fund to pay Qifubiaozhun, according to the "Regulations" (Decree No.68, the same below) the provisions of Article 32 of the Qifubiaozhun 50% execution.
The medical expenses incurred by the insured in the family sickbed treatment at the designated community health service center (station) shall be determined according to 50% of the Qifubiaozhun paid by the basic medical insurance pooling fund and transferred to hospitalization, and the Qifubiaozhun paid by the basic medical insurance pooling fund shall be implemented according to the Qifubiaozhun stipulated in Article 32 of the Regulations.
The cumulative maximum payment limit of medical expenses paid by the basic medical insurance pooling fund to employees and retirees in a year is determined by about 4 times the average salary of employees in this city in the previous year (200 1 is 50,000 yuan).
Four, the basic medical insurance fund to pay medical expenses to set the settlement cycle.
1. The hospitalization of the insured shall not exceed 90 days, and each hospitalization shall be a settlement period; For medical expenses exceeding 90 days, every 90 days is a settlement cycle, and after settlement, it will be regarded as the second hospitalization; those exceeding 180 days will be regarded as the third hospitalization, and those exceeding 270 days will be regarded as the fourth hospitalization.
2. The medical expenses of outpatient radiotherapy and chemotherapy for patients with malignant swelling and pain shall be settled every 360 days.
3. The medical expenses incurred by patients who need long-term renal dialysis treatment, patients who need to take anti-rejection drugs for a long time after renal transplantation and patients with mental illness who really need to be hospitalized for many years shall be settled every 360 days.
(Calculation of dialysis cost: Dialysis cost includes start-up cost, heparin, normal saline, dialysate, dialysis tube, disposable materials, etc. However, other drugs cannot be included in the calculation of dialysis cost. For example, the expenses of EPO, such as Luo Ca, are paid from the large mutual fund in accordance with the provisions on the payment of outpatient medical expenses, and cannot be paid from the basic medical insurance pooling fund. If hemodialysis is carried out in the following seven hospitals, such as Beijing Tiantan Hospital, Beijing anzhen hospital, Peking University Third Hospital, Dongzhimen Hospital of Beijing University of Chinese Medicine, Dongfang Hospital of Beijing University of Chinese Medicine, General Hospital of Posts and Telecommunications, and General Hospital of Beijing Electric Power, it is still carried out according to document [2000] 143, that is, the per capita expenses within 4 10 yuan include dialysate, puncture needle, physiological saline, etc. )
Five, the basic medical insurance fund and individual payment according to the following provisions.
In a settlement period, the medical expenses incurred by employees and retirees shall be calculated by sections and paid cumulatively according to the level of the hospital and the amount of expenses, and shall be shared by the basic medical insurance fund and individuals according to the following proportions (the proportion of retirees' payment is 60% of that of on-the-job employees):
(1) Medical expenses incurred in tertiary hospitals:
1. Minimum deductible line 1 000 yuan, 80% will be paid by the overall fund and 20% by the employees;
2. For the part exceeding 1000 yuan to 30,000 yuan, the overall fund will pay 85%, and the employees will pay15%;
3. For the part exceeding 30,000 yuan to 40,000 yuan, 90% shall be paid by the overall fund and10% shall be paid by individual employees;
4 more than 40 thousand yuan, the overall fund to pay 95%, workers pay 5%.
(2) Medical expenses incurred in secondary hospitals:
1. For the minimum deductible of 1 000 yuan, 82% will be paid by the overall fund and18% by the employees;
2. For the part exceeding 1000 yuan to 30,000 yuan, the overall fund will pay 87%, and the employees will pay13%;
3 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 92%, 8% workers pay;
4 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.
(3) Medical expenses incurred by first-class hospitals and family beds:
1. The minimum deductible 1 0,000 yuan, 85% paid by the overall fund and15% paid by the employees;
2. 10000 yuan to 30000 yuan, 90% of the overall fund and 0/0% of the employees;
3 more than 30 thousand yuan to 40 thousand yuan, the overall fund to pay 95%, workers pay 5%;
4 more than 40 thousand yuan, the overall fund to pay 97%, workers pay 3%.
Six, large medical expenses mutual fund payment in accordance with the following provisions
1. For the part of outpatient and emergency medical expenses exceeding 2,000 yuan within one year, 50% of the large medical expenses will be paid by mutual funds and 50% by individuals.
2. For retirees whose outpatient and emergency medical expenses exceed 1500 yuan in a year, 60% will be paid by mutual fund for large medical expenses and 40% by individuals for retirees under 70 years old; For retirees over 70 years old, 70% of the large medical expenses are paid by mutual funds and 30% by individuals.
3 workers and retirees outpatient and emergency medical expenses within a year of large medical expenses mutual fund maximum payment limit of 20000 yuan.
4. Employees and retirees exceed the maximum payment limit of the basic medical insurance pooling fund (excluding the following Qifubiaozhun and personal burden) for hospitalization medical expenses, radiotherapy and chemotherapy for malignant tumors, renal dialysis and outpatient medical expenses for taking anti-rejection drugs after renal transplantation, with 70% paid by the mutual fund for large medical expenses and 30% paid by individuals. However, the maximum amount of medical expenses paid by mutual funds in one year is 654.38+10,000 yuan.
Seven, the basic medical insurance fund will not pay medical expenses.
The first part is clearly stipulated in Decree No.68 of the municipal government and related documents.
1. See a doctor in a medical institution other than my designated place, except for emergency (you must see a doctor in the nearest designated medical institution);
2. Buy medicines at non-designated retail pharmacies;
3. Injuries caused by traffic accidents, medical accidents or other accidents;
4 drug abuse, fighting or other illegal acts causing injuries;
5 for suicide, self-mutilation, alcoholism and other reasons to receive treatment;
6. Receiving treatment abroad or in Hongkong, Macao Special Administrative Region and Taiwan Province Province;
7 in accordance with the provisions of the state and the city should be paid by individuals.
Unlike industrial injury insurance, medical insurance can only be reimbursed if it exceeds the deductible. Of course you can't take medical insurance. Since it is caused at work, you should declare a work-related injury, and even if you can't identify the grade, you can reimburse the medical expenses. Now that you haven't handled the work-related injury, your expenses will naturally be paid by your company. Find a company to reimburse you, don't lose yourself. I hope you get well soon!
In your case, the deductible should not be involved. I only know that the deductible for employees in Beijing is 1800 yuan. You can ask the personnel of the unit.