First, students and children. In a settlement year, medical expenses below RMB 6,543,800+0,800 yuan that meet the scope of reimbursement occurred. The threshold for tertiary hospitals is 500 yuan, and the reimbursement ratio is 55%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
Second, the elderly over 70 years old. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The qifubiaozhun for secondary hospitals is 300 yuan, and the reimbursement rate is 60%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 65%.
Third, other urban residents. In a settlement year, medical expenses below RMB 6,543,800+that meet the scope of reimbursement occur, and the threshold of tertiary hospitals is 500 yuan, and the reimbursement ratio is 50%; The Qifubiaozhun for hospitalization in secondary hospitals is 300 yuan, and the reimbursement rate is 55%; There is no Qifubiaozhun in first-class hospitals, and the reimbursement rate is 60%. Urban residents hospitalized for more than two times in a settlement year, starting from the second hospitalization, no longer charge Qifubiaozhun fees. Transfer or hospitalization for more than two times, make up the difference of Qifubiaozhun in accordance with the provisions of transfer or hospitalization again.
legal ground
"Medical Insurance Laws, Regulations and Rules" Article 27 The employees of the employer who pay the basic medical insurance premiums in accordance with these regulations shall enjoy the basic medical insurance benefits.
Twenty-eighth personal accounts are used to pay medical expenses beyond the scope of the overall fund; If the personal account is insufficient to pay, it shall be borne by me.
Twenty-ninth serious illness hospitalization medical expenses, according to the following methods to pay:
(a) Qifubiaozhun in principle control in the city, county, autonomous county last year, the average social wage of workers 9%-0%.
(two) the maximum payment limit is controlled in principle at 3-5 times of the average social wage of employees in cities, counties and autonomous counties in the previous year.
(three) medical expenses above the minimum deductible and below the maximum payment limit are mainly paid by the overall fund, and individuals bear a certain proportion. Give appropriate care to the proportion of retirees who bear medical expenses. The scope of serious diseases, the specific standards of Qifubiaozhun and the maximum payment limit, and the proportion of sharing medical expenses above Qifubiaozhun and below the maximum payment limit shall be determined by the provincial people's government.
Thirtieth medical expenses below Qifubiaozhun and above the maximum payment limit shall not be paid by the overall fund.
Thirty-first basic medical insurance fund to pay part of the cost of diagnosis and treatment projects and class B drugs list, the proportion of individual pays, determined by the provincial people's government.
Thirty-second medical expenses of class A infectious diseases such as cholera and plague shall be paid by the overall fund. The medical expenses of explosive and epidemic infectious diseases confirmed by the administrative department of health shall be solved by the people's government.
Article 33 State civil servants and other qualified personnel shall, on the basis of participating in basic medical insurance, implement medical subsidies. In order to solve the medical expenses above the maximum payment limit for personnel other than those specified in the preceding paragraph, the provincial people's government may organize the implementation of supplementary medical insurance.
Article 34 Anyone who has reached the age of 50 at the time of participating in the basic medical insurance and has worked continuously or for less than 5 years according to state regulations can enjoy the treatment of pooling funds to pay medical expenses after participating in the basic medical insurance for 1 year.
Article 35 The payment period stipulated in these Regulations includes the actual payment period and the deemed payment period. The term "deemed payment period" as mentioned in the preceding paragraph refers to the continuous length of service or working years that meet the requirements of the state before the implementation of these regulations.
Thirty-sixth employees who retire after the implementation of these regulations shall pay the basic medical insurance premium for men for 30 years and women for 25 years. After retirement, their basic medical insurance benefits shall be implemented according to the provisions of these regulations. When an employee retires, if the payment period of the basic medical insurance premium does not reach the provisions of the preceding paragraph, the basic medical insurance benefits he enjoys after retirement will be reduced by 5% on the prescribed treatment standard for each full payment period 1 year.
Thirty-seventh retirees actually pay the basic medical insurance premium 10 years before retirement, and the original unit does not pay the basic medical insurance premium after retirement, which does not affect their enjoyment of the basic medical insurance benefits for retirees stipulated in these regulations. Retirees who actually paid the basic medical insurance premium before retirement were less than 10 years, and those who did not pay the basic medical insurance premium after retirement did not enjoy the basic medical insurance benefits for retirees stipulated in these regulations.
Thirty-eighth workers and retirees due to alcoholism, suicide, self-mutilation, illegal and criminal expenses, the overall fund will not pay. Medical expenses incurred due to traffic accidents and medical accidents shall be handled in accordance with relevant state regulations.
Thirty-ninth approved by the social insurance agencies in different medical institutions for medical treatment, retirees living in different places for more than 0 years, the basic medical insurance benefits in accordance with these regulations.
Fortieth medical expenses incurred by employees and retirees abroad or in Hongkong, Macao and Taiwan Province Province shall be implemented with reference to these Regulations.