1. Outpatient medical expenses: within the scope of basic medical insurance payment (within the maximum payment amount from the deductible line to the capping line), after deducting the deductible line 1800 yuan from the "self-pay one" part, it will be 20% (25% for model workers and extremely poor employees).
2. Hospitalization medical expenses: within the scope of basic medical insurance payment (within the maximum payment amount from the deductible line to the capping line), the "self-pay one" part of the expenses borne by the employees is deducted for the first hospitalization 1.300 yuan (650 yuan is deducted for the second hospitalization; 650 yuan was deducted for the first hospitalization of poor workers, and 325 yuan was deducted for the second hospitalization. After the deductible, the mutual aid is calculated at 20% (25% for model workers and poor workers).
3. Outpatient and inpatient medical expenses above the capping line: After the "self-pay-one" expenses of outpatient and inpatient employees reach the capping line of basic medical insurance, there will still be out-of-pocket expenses within the scope of medical insurance, and 40% of them can enjoy mutual aid from the capping line to 50,000 yuan, with a maximum reimbursement of 20,000 yuan; 50,000 yuan to 654.38+million yuan, you can enjoy 60% mutual aid, and the maximum reimbursement amount is 30,000 yuan; 100000 yuan to 150000 yuan, you can enjoy 80% mutual aid, and the maximum reimbursement amount is 40000 yuan.
What items does medical insurance reimbursement include?
The classification of medical insurance reimbursement and the items included are as follows:
1, general medical insurance. It mainly includes outpatient expenses, medical expenses and inspection expenses.
2. Hospitalization insurance. Mainly the daily hospitalization expenses, hospital equipment use expenses, operation expenses, medical expenses and so on.
3. Surgery insurance. Provide all expenses incurred due to the patient's need for necessary surgery.
4. Comprehensive medical insurance. Its cost range includes all expenses such as medical treatment, hospitalization and surgery.
5. Special disease insurance. Some special diseases often bring disastrous expenses to patients, which ordinary families can't bear. Such as cancer and heart disease. The major diseases that provide protection for the insured can be single diseases, such as malignant tumors, or even some cancers in malignant tumors.
I hope the above content can help you. Please consult a professional lawyer if you have any other questions.
Legal basis: People's Republic of China (PRC) Social Insurance Law.
Article 24 The state establishes and improves the new rural cooperative medical system.
Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25 The state establishes and improves the basic medical insurance system for urban residents.
The basic medical insurance for urban residents combines individual contributions with government subsidies.
People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.