Medical insurance for urban residents does not include large supplementary medical insurance. Whether you can participate depends on whether there is supplementary medical insurance in the local area.
The difference between medical insurance for urban residents and large supplementary medical insurance;
First, the scope of reimbursement of medical insurance for urban residents
(a) diagnosis and treatment equipment and medical materials
1, using X-ray computed tomography (ct), stereotactic radiotherapy device (γ knife, χ knife), cardiac and angiographic X-ray machine (including digital subtraction equipment), magnetic resonance imaging device (mei), single photon emission computerized scanning device (spect), color Doppler instrument, medical linear accelerator and other large medical equipment.
2. Extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy
3. Pacemakers, artificial joints, intraocular lenses, vascular stents and other materials are used to replace artificial organs in vivo.
4, the provisions of the provincial price department can be charged separately for disposable medical materials.
(2) Treatment items
1, hemodialysis, peritoneal dialysis
2, kidney, heart valve, cornea, skin, blood vessels, bones, bone marrow transplantation
3. Cardiac laser drilling, anti-tumor cellular immunotherapy and fast neutron therapy projects.
(three) the inspection and treatment items and medical materials of medical instruments and equipment with a single cost of more than 400 yuan.
Two, large supplementary medical insurance compensation
After the insured person enters the large medical insurance payment, the medical expenses that meet the requirements of the basic medical insurance for in-patient and outpatient emergency rescue, outpatient treatment of serious diseases and chronic diseases shall be accumulated by the large medical insurance fund and the insured person in proportion, with the same burden. The specific criteria are:
(a) more than 45 thousand yuan to 6.5438 million yuan (including 6.5438 million yuan), 94% of the large medical insurance fund, and 6% of the insured person pays; 65438+ 10,000 yuan to 200,000 yuan (including 200,000 yuan), 96% paid by the large medical insurance fund and 4% paid by the insured; More than 200,000 yuan, 98% is paid by the large medical insurance fund, and 2% is paid by the insured.
(II) If the medical expenses of the insured for using the diagnosis and treatment items and Class B drugs in the basic medical insurance drug list belong to the basic medical insurance pooling fund, 65,438+00% shall be paid by the individual first, and 30% shall be paid by the individual for the approved blood use, and the balance shall be borne by the large medical insurance and the insured according to the prescribed proportion.
(3) The insured uses artificial organs and implanted materials in vivo that meet the requirements of the basic medical insurance, of which individuals pay 35% and large medical insurance pays 65%; If it is imported, the individual will pay 50% and the large medical insurance will pay 50%.
Large medical insurance In an insurance year, the maximum amount of medical expenses paid to each insured person is 300,000 yuan.