1, the standard of payment.
Medicare first class: the contribution rate of 8.2% (basic + local subsidies), of which the unit to pay 6.2%, individual contributions to pay 2%.
Medicare second grade: monthly contribution of 59.84 yuan, of which, the individual to pay 14.96 yuan, the unit to pay 44.88 yuan.
2, general outpatient treatment.
Medicare 1: The individual account is used to pay for the participant's medical expenses within the scope of the general outpatient medical insurance catalog.
Medicare II: drugs belonging to Class A and Class B are paid for by the Community Outpatient Coordination Fund at the rate of 80% and 60%, respectively;
3. Individual account family **** relief.
Medicare first class: the amount accumulated in the personal account exceeds 5% of the average salary of the on-the-job workers in the previous year in the city, and the part exceeding that can go to the designated pharmacy to buy non-prescription medicines within the scope of the medical insurance catalog.
Medicare second grade: none.
4. Personal account insufficient payment.
Medicare first grade: continuous participation in the insurance for one year, in the same medical insurance year, out-of-pocket basic outpatient medical expenses and local subsidized medical expenses exceeding 5% of the average salary of on-the-job workers, the excess portion of the integrated fund shall be paid by the provisions of the 70% (over 70 years of age shall be paid 80%).
Medicare second class: none.
5. Expenses incurred for outpatient large equipment examination and treatment.
Medicare first class: 80% paid by the integrated fund according to the regulations.
Medicare II: paid according to the unit price of general diagnostic and treatment items up to a maximum of 120 yuan.
6. General outpatient blood transfusion costs.
Medicare first-tier: 90% paid by the integrated fund in accordance with the regulations.
Medicare II: 70% will be paid by the integrated fund according to regulations.
7. Physical examination subsidies.
Medicare first grade: a lump sum of 500 yuan after retirement, 20 yuan per person per month (70 years of age for 40 yuan per person per month).
Medicare second grade: none.
8. Treatment of medical treatment outside the city.
Medicare first class: general outpatient expenses, outpatient expenses for major diseases, and hospitalization expenses can be reimbursed according to regulations.
Medicare II: general outpatient expenses are not reimbursed; outpatient expenses for major diseases and hospitalization expenses are reimbursed in accordance with the regulations.
Legal basis:
The Social Insurance Law of the People's Republic of China:
Article 29: The portion of the medical expenses of the insured that shall be paid by the basic medical insurance fund shall be settled directly by the social insurance administration organization with the medical institutions and the pharmaceutical business units. The administrative departments of social insurance and the administrative departments of health shall establish a settlement system for medical expenses incurred for medical treatment in other places, so as to facilitate the enjoyment of basic medical insurance by insured persons.
Article 23: Employees shall participate in the basic medical insurance for employees, and the employer and employees shall pay the basic medical insurance premiums in accordance with state regulations***. Individual industrial and commercial households without employees, part-time workers who do not participate in the basic medical insurance for employees in their employing units, and other flexibly employed persons may participate in the basic medical insurance for employees, and individuals shall pay the basic medical insurance premiums in accordance with the state regulations.