Taking Zhengzhou as an example, according to Article 29 of the Measures for the Basic Medical Insurance of Workers in Zhengzhou City, the hospitalization medical expenses that exceed the deductible and do not exceed the maximum payment limit shall be paid by the overall fund according to the following proportions:
(1) When employees are hospitalized, the proportion of the overall fund payment is: 95% in community health service institutions, 95% in first-class medical institutions, 90% in second-class medical institutions and 88% in third-class medical institutions;
(2) When retirees are hospitalized, the proportion of the overall fund payment is 97% for community health service institutions, 97% for first-class medical institutions, 95% for second-class medical institutions and 93% for third-class medical institutions.
The annual cumulative maximum payment limit of the overall fund is 6,543,800 yuan+0.5 million yuan. After the cumulative payment of the overall fund reaches the maximum payment limit in the natural year, the medical expenses exceeding the limit shall be paid by the employee's commercial supplementary medical insurance, and the specific measures shall be implemented according to the existing regulations.
Extended data:
Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations.
Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.
Zhengzhou Municipal Government-Measures of Zhengzhou Municipality on Basic Medical Insurance for Employees