The portion of the out-of-pocket medical expenses of the insured that exceeds the per capita disposable income of urban residents in the city in the previous year after they have enjoyed the basic medical insurance benefits for urban residents in the current year is included in the scope of payment of major disease insurance. The out-of-pocket medical expenses included in the scope of reimbursement for major disease insurance include:
Medical expenses below the starting standard of the basic medical insurance fund for urban residents;
Medical expenses above the starting standard and below the maximum payment limit of the basic medical insurance fund for urban residents which should be borne by the urban residents in accordance with the proportion of the medical expenses;
The Class B medicines in the "List of Drugs in Beijing Municipal Basic Medical Insurance, Work Injury Insurance and Maternity Insurance" shall be included in the scope of payment of the major disease insurance. The medical expenses that should be borne by the Class B drugs in the Catalog of Beijing Basic Medical Insurance and Work Injury Insurance and Maternity Insurance should be borne by the medical expenses in advance.
The major medical insurance is implemented by "segmented calculation and cumulative payment"; the part above the starting standard (not included) and the out-of-pocket medical expenses up to RMB 50,000 (included) will be paid by the fund of the major medical insurance by 50%, and the out-of-pocket medical expenses above RMB 50,000 (not included) will be paid by the fund of the major medical insurance by 60%, with no upper limit; The medical insurance is settled once a medical insurance year. 50% of the reimbursement is up to 50,000 yuan, and 60% of the reimbursement is over 50,000 yuan. The specific reimbursement rate is recommended to call the Social Security Administration customer service hotline to inquire.