1, what is the basic medical insurance personal account?
Personal accounts are established by the medical insurance institutions of the insured. Personal account fund rights and interests of the insured, outpatient medical expenses and drug purchase in pharmacies. And can be carried forward and inherited.
2. What is a self-funded drug? What is the self-funded project?
Drugs that do not belong to the list of essential drugs, such as health care drugs, are self-funded drugs and are not covered by reimbursement.
Basic medical insurance reimbursement process, Class A drug list and Class B drug list, in which they need to spend 20% of the expenses, which are self-funded items. In addition, special medical expenses, such as CT and MRI, are also self-funded items.
3. How is a natural year divided?
65438+ 10 1 to 65438+February 3 1 is a calendar year. If you were hospitalized on February 30, 2004, you were discharged on October 5, 2005, and then the reimbursement amount involved in 2005.
4. How to choose a designated hospital? If I choose to be treated in a hospital, does it mean that I will be fixed after being treated in this hospital?
Designated hospitals are the audit of cooperation agreements confirmed and signed by labor and social security departments and hospital social security institutions. You can choose a suitable designated hospital according to your own needs, and there is no fixed one.
5. Reimbursement is required after discharge. What information do you need to provide? Is there a time limit?
If your hospital computer is connected to the social security bureau, you can directly leave the hospital through card withdrawal settlement, and the network hospital will be fully promoted after discharge, which is related to the reimbursement of the social security bureau.
If you are admitted to a hospital in the city, go to the Social Security Bureau for reimbursement within two months after discharge; Outside the city, submit an expense account to the social security bureau within 3 months after discharge. The reimbursement place is on the third floor of Chengdu Social Security Bureau. You need to bring social security card, ID card, discharge certificate, expense list and invoice. Working hours are from 9:00 am to 12:00 am and from 6:00 pm to 5:00 pm from Monday to Friday.
case analysis
It is more complicated. Because of the provisions of basic medical insurance, in order to better understand the policy, we use case analysis to explain it. The basic medical insurance is mainly divided into two parts: outpatient service and hospitalization. Let's explain it separately.
First, hospitalization reimbursement
Under normal circumstances, those who live in hospitals, rather than those with a higher proportion, are reimbursed by tertiary hospitals, and the reimbursement is even greater.
Less than 46,000, 40-year-old Chen was hospitalized in a designated hospital, and the medical expenses cost 30,000 at a time (excluding self-funded and special expenses). Ok, the basic medical insurance in Chen You, the reimbursement amount at this time is:
(30000-8084×12% )× [(75+40× 0.2) ÷100] = 29029.92× 83 (%) = 24094.83 yuan.
The costs that individuals need to bear are:
30000-24094.83 = 5905. 17
If you live in a designated hospital, the reimbursement amount is:
(30,000-8084× 5% )× (75+40× 0.2) ÷100 = 29595.8× 83% = 29598+0 yuan. 39696.88868886686
Individualized demand at reasonable cost is:
More than 46,000 yuan, 30,000-24,564.5438+0 = 5,435.49 yuan is Liu 50 years old.
For example, the one-time medical expenses of designated hospitals are 60,000 yuan (excluding self-funded and special expenses). Formula should be reimbursed for basic medical expenses:
(60000-8084× 5% )× [(75+50× 0.2) ÷100 = 59029.92× 85% = 50175.43 yuan.
BR/>； However, according to the stipulated basic medical insurance, the total amount of reimbursement in a natural year cannot exceed 4 times of the average salary of the whole city in the previous year. At present, it is 46,336 yuan in Chengdu. Liu formula reimbursement expenses exceed the upper limit.
Therefore, at this time, the actual reimbursement expenses are 46,336 yuan, and the expenses to be borne by individuals are:
60000-46336 = 13664 yuan
B, outpatient reimbursement
The social security institution shall establish a personal account for basic medical insurance for each insured person. The amount in my personal account is used to buy medicine or outpatient medical expenses with my credit card, and the hospital pays part according to the regulations. Outpatient and personal account balance is paid in cash, and my savings can be inherited according to law.
Next, let's introduce the working people, retirees and freelancers.
In-service employee
First of all, my monthly salary is paid by all individuals in my personal account (that is, 2%), so part of the premium paid also includes my personal account. The formula for the monthly increase of my personal account is:
Worker 50 years old: (my monthly salary × 2%)+ (my monthly salary * 0.02% * my age)
Examples of old workers and workers with 50 years (my monthly salary × 2%)+ (my monthly salary × 0.035% according to my age)
Wang, aged 30, has a monthly salary of 1000 yuan, and the total monthly amount should include Wang's personal account: (1000× 2%)+(1000× 0.02 %× 30) = 26.
Jiang is 52 years old, with a monthly salary of 1200 yuan. The monthly total should include Jiang's personal account: (1, 200×2%)+( 1, 200× 0.035 %× 52) = 2421.84 = 45.84 yuan.
retire
The calculation formula for the monthly increase of personal account is:
Last year, the average monthly salary of employees in the city was × 2%+, and the average monthly salary last year was × 0.035% × my age growth.
If the monthly pension of my retirees is higher than the average monthly salary of the previous year, I will be included in the basic old-age insurance for one month.
Zhang, 6 1 year-old, monthly pension 1000 yuan (the average monthly salary of employees in Chengdu last year was more than 965 yuan), which should be included in the personal account every month:
(1000× 2%)+(1000× 0.035 %× 61) = 41.35 yuan.
The basic old-age insurance premium for Mr. Huang at the age of 62 is 800 yuan per month (lower than the average monthly salary of employees in Chengdu, about 965 yuan), and the amount that should be included in the personal account every month is:
(965× 2%)+(965× 0.035 %× 62) = 40.3 yuan.
freedom
The calculation method of personal account monthly increase is as follows:
50-year-old age: urban average monthly salary ×2%+ urban average monthly salary × 0.02% × my age.
50 years old and above: the city's average annual salary ×2%+ the city's average monthly salary × 0.035% × age. (Chengdu's average monthly salary is 965 yuan)
take for example
Zhu, 40 years old, is a freelancer, and his monthly personal account is:
(965× 2%)+(965× 0.02 %× 40) =19.37.72 = 27.02 yuan.
Guide to workers' health insurance
& gt
1, is this a designated medical institution?
Designated medical institutions: designated medical institutions determined by the social insurance management office of the bureau and local labor and social security administrative departments, and the locations selected and announced by designated medical institutions.
2. What about the doctor's clinic?
Designated medical institutions:
The designated pharmacies of the Ministry of Social Security can purchase medical drugs directly by swiping their cards, publish them online, reduce costs, and transfer funds directly to personal accounts.
Local designated medical institutions: the expenses for medical treatment, medicine taking and first self-improvement in the designated medical institutions of social insurance of the local Ministry of Labor and Social Security will be reimbursed and purchased into the personal account of the local railway hospital to offset the funds.
The medical process is as follows:
Medical institutions: → Cancel personal medical insurance cards and IC cards, and enter medical records registered by computers. Here →→→→ Plan the operation price → Handle → Holder → Check-in, IC card account to pay prescription drugs → Check, handle and get medicine.
Designated medical institutions: → cash payment → pharmacy sale → holding valid certificates → unit area? The railway hospital in the jurisdiction reduces the individual plan price →→→→→ The holder checks the application form, and the prescription fee is registered in their medical records →→→→→→→→ the outpatient account.
Expense reimbursement:
Medical institutions can directly collect credit card funds from personal accounts, and the expenses of local designated medical institutions are personal progress first, and then the institutions that issue relevant bills will make overall provision for self-care and insufficient funds in personal accounts.
3. What should we pay attention to in severe crisis rescue?
Principles of treatment:
The principle of treatment is to receive life-saving treatment in the nearest designated and non-designated hospitals.
After emergency rescue and temporary disposal, the nearest non-designated hospitals and designated medical institutions should be reversed in time. Irreversible timely emergency certificate, family members or units should be kept within 3 days (holidays postponed), and the situation will be summarized to the Bureau of Social Insurance Management Office (Guiyang, Chongqing Medical Insurance Management Office) for approval and filing.
Expense reimbursement: the reimbursement calculation is the same.
Hospitalization medical expenses. Hospitalization emergency rescue expenses should be calculated into unified hospitalization medical reimbursement.
4. What are the regulations for special outpatient diseases?
What is outpatient special disease?
What is a special disease in outpatient department?
After that, the insured needs long-term outpatient treatment for illness. In the case of stable condition, medical expenses are high and diseases occur.
Patient-specific diseases
The provisions of the cooperative areas include:
Sichuan unit: divided into two categories. The first category: after a definite diagnosis, you can rely on drugs to treat diseases in outpatient department: (1) diabetes; ② stage Ⅱ and Ⅲ hypertension; ③ Aplastic anemia; ④ Graves disease; ⑤ Sequela of cerebrovascular accident; ⑥ Mental illness (stable period); ⑦ Cirrhosis; 8 Hepatitis A, B, CD and E; Pet-name ruby lung heart disease; Go to school in Parkinson's disease. The second category: outpatient treatment of stable diseases: ① radiotherapy, chemotherapy and postoperative adjuvant treatment of malignant tumors; ② Chronic leukemia; ③ Systemic lupus erythematosus; ④ Dialysis treatment of chronic renal failure; ⑤ Drugs for immune rejection after kidney (liver) transplantation.
Monetary unit: dialysis treatment of various malignant tumors, aplastic anemia, hemophilia, systemic lupus erythematosus and chronic renal failure, and anti-rejection treatment after organ transplantation included in the diagnosis and treatment project.
Chongqing Setting: 1, Chemotherapy and analgesia for malignant tumor; 2. Dialysis treatment for patients with renal failure; 3. 1 type diabetes mellitus, type ⅱ 2,5, anti-rejection therapy after kidney, heart valve and hematopoietic stem cell transplantation in patients with systemic lupus erythematosus; 6, hypertension, hypertension, high-risk and extremely high-risk, grade 2 hypertension, hypertension 3, 7, coronary heart disease, rheumatic valvular heart disease; 9. Cerebrovascular accident, cerebral infarction, cerebral hemorrhage, sequelae of subarachnoid hemorrhage 10, bronchial asthma, chronic bronchitis, emphysema, chronic pulmonary heart disease 16, liver cirrhosis, decompensated period 12, aplastic anemia 13, schizophrenia/kloc-0.
Management principles of outpatient special diseases: the implementation of the disease, medical institutions, treatment programs, cost control standards within the scope of administration, and subsidy period. ?
Four,
1, the report of the unit hospital, so that my condition can be diagnosed (examination, laboratory report, etc. ) belongs to hospitalization medical insurance. Where necessary, I need to fill in the application form for special diseases of employees in Chengdu, Sichuan, and clearly declare the diseases (the unit in Chongqing has received the application form).
2. Make a preliminary examination of the hospital, make necessary examination and confirmation of the diagnosis results, suggest the treatment plan, drug name and treatment time range.
3. Return the personal appointment joints and outpatient prescription information of special diseases to the hospital every month, and the hospital will submit the personal information of the approval mark of the social insurance management consent, and the hospital will inform the welfare treatment, so that you can begin to enjoy the outpatient treatment of special diseases.
Personal records of retirees living in different places are treated in local designated hospitals, but they need to be returned, social security, filled in in the hospital and paid with relevant information recognized by the social security department.
Fifth, how to reimburse outpatient expenses for special diseases?
Former railway hospital: the personal part that should be paid directly by credit card first reduces the funds in personal account, and a small amount of cash payment reimbursement is automatically compensated through the network. BR/>； Resettlement of employees in different places: quarterly reimbursement of hospitalization expenses of local inter-departmental social security institutions.
Six, expense reimbursement standards
The basic medical insurance fund reimbursement scope:
(1) Sichuan unit: Accumulate outpatient expenses for specific diseases by natural year.
Payment from the overall planning fund: for the part of the first-class diseases that exceeds 400 yuan in the natural cumulative safety range, 40% of the retired and in-service will be paid by the overall planning fund at the rate of 60% every year, and the cumulative payment from the overall planning fund in natural years will not exceed 1000 yuan 1500 yuan. Two kinds of diseases in a natural year, the safety of more than 9.7 million yuan, paid by the overall fund in accordance with the proportion of 80%;
(2) Monetary unit: in each natural year, the outpatient medical expenses for special diseases shall be borne by individuals, and the part from 700 yuan to 5,000 yuan (including 5,000 yuan, the same below) shall be borne by individuals, accounting for 20%; More than 5000 yuan 10000 yuan, personal burden15%; Personal burden of more than 10,000 yuan15,000 yuan,15,000 yuan above the ceiling line, personal burden of 5%.
Retirement individuals have a 70% burden.
(3) In Chongqing, Qifubiaozhun and hospitalization expenses of the current year are calculated and paid by individuals at one time. When the outpatient medical expenses for special diseases exceed the deductible line and are lower than the capping line, the proportion of the overall fund payment: 90% of the expenses of anti-rejection drugs for cancer patients and patients with advanced chemotherapy, radiotherapy and analgesia, dialysis patients and organ transplantation; Other special diseases pay 80%, the same patient is treated in two designated medical institutions, and the deductible expenses are determined by high-level medical institutions.
2. Supplementary medical insurance reimbursement:
The rest of the overall reimbursement will enter the supplementary medical retirement, and 70% will be reimbursed according to 90%, and 90% will be reimbursed by the social pooling fund above the maximum payment limit.
3. capping line: in a natural year, the total amount of specific diseases and hospitalization expenses paid by the overall fund and the supplementary medical insurance fund to individual patients shall not exceed the capping line of the basic medical insurance and the supplementary medical insurance fund.
5. Provisions on hospitalization and reimbursement?
How to go through the hospitalization and discharge procedures?
1, hospital: medical insurance card, IC card, admission ticket →→→→→→ hospitalization procedures (payment of advance payment for hospitalization) →→→→→→→→→→→ settlement and discharge procedures, only paying part of medical expenses paid by individuals.
2. Social security is announced in local designated hospitals: my medical insurance card, unit certificate, ID card, admission ticket →→→→→→→→ hospitalization →→ copying hospitalization and discharge procedures (paying hospitalization advance payment), preparing relevant reimbursement materials → settlement → comprehensively promoting medical expense reimbursement information.
Preparation for discharge: unified medical income related to local provinces and cities (original), expenses in the list, discharge certificate (original), emergency medical records (emergency) and objective medical records, and medical certificate and card attached to the unit certificate for reimbursement.
3. The whole area? The medical treatment process of the former railway hospital and the reimbursement of the treatment enjoyed by the local designated hospital bureau.
2. What is the expense reimbursement scheme?
Coordinate with regional hospitals: no reimbursement is required, and the discharge settlement has been reimbursed through the network. The reimbursement information of other local designated hospitals and former railway hospitals managed by the bureau is the inter-unit social security bureau (medical insurance bureau, Chongqing). According to the regulations, the amount of reimbursement compensation is wired to the unit for review, and the unit I noticed receives cash.
Examples of calculation methods for reimbursement of hospitalization expenses:
(1) In Sichuan:
For example, the retired workers' party (who bought supplementary medical insurance) was born in August 1934, was treated in Sichuan Provincial People's Hospital, and was discharged with medical expenses of 290,000 yuan. Out-of-pocket expenses are 2,500 yuan, Class B drugs and some expenses are 30,000 yuan, imported implant materials are 30,000 yuan, and blood expenses are 5,000 yuan.
In which: compliance cost = 290,000-25,000-30,000× 20%-30,000× 36%-5,000× 60% = 267,700 yuan.
Basic medical insurance reimbursement:
Reimbursement ratio = (75+70× 0.2 )× 100% = 89%
The total payment amount is (267,700-970) × 89% = 237,389.70 yuan.
Because the top line of 237,389.70 >: 35,000 overall payment and the actual overall payment are 35,000 yuan.
2. Supplementary medical insurance reimbursement:
Above the threshold cost, the following part of the subsidy capping line:
(35000/89%-35000) × 90% = 3893.26 yuan br/>; Subsidies above the top line of basic medical insurance:
Total cost = 267,700-970-35,000/89% = subsidy amount 227,404.16 yuan.
= 227404.16× 90% = 204663.74 yuan
Because 204663.74 >:654.38+0.5 million yuan, the payment amount of supplementary medical insurance is 654.38+0.5 million yuan-the treatment of supplementary medical insurance is 3893.26 = 654.38+0.46,654.38+0.06. 74 yuan.
Total reimbursement of supplementary insurance: 3893.26+$ 146, 106.74 = 150000.
3, the basic medical insurance+supplementary medical insurance reimbursement:
35000 + 150000 = 185000
Personal pocket: 290000-185000 =105000 yuan.
If you don't participate in supplementary medical insurance, you need to pay 255 thousand yuan.
(2) Monetary unit of Example 2
In this year, employees were hospitalized in local tertiary hospitals due to illness, and the medical expenses were 30,000 yuan, including the first hospitalization of Class B drugs list 1.2 million yuan; The large medical equipment for inspection is 1200 yuan, and the calculation method is as follows:
1, basic medical insurance reimbursement:
(1) Calculate the total personal burden: 2640. ：
Personal burden of drugs (b): 12000× 20% = 2400 yuan, personal burden of special inspection and special treatment: 1200× 20% = 240 yuan's share of medical expenses, excluding the first installment of 27360 yuan.
(2) Split shares:
Personal burden ***3588 yuan:
Deductible line: 900 yuan (Third Hospital)
Paragraph 1: 5000-900× 20% = 820 yuan.
Paragraph 2:10000-5000×15% = 750 yuan.
Paragraph 3:15000-10000×10% = 500.
Paragraph 4: 27360-15000× 5% = 618.
The total amount of collective funds is 23,772 yuan, and the amount is:
Paragraph 1: 5000-900× 80% = 3280 yuan.
Paragraph 2: 10000-5000× 85% = 4250 yuan BR/> Paragraph 3:15000-10000× 90% = 4500 yuan.
Paragraph 4: 27360-15000× 95% =11742 yuan.
Total of the above items: 6,228 yuan for individuals, accounting for 20.76% of the total expenditure, and 23,772 yuan for reimbursement from the overall fund, accounting for 79.24% of the total expenditure.
2. Supplementary medical insurance reimbursement:
Reimbursement = (27360-900-23772) × 70% =1881.6 yuan/>+Total value-added reimbursement:
237721881.6 = 25653.6 yuan. "
Individuals need to pay: 30,000-25,653.6 = 4,346.4 yuan.
(Individuals who did not participate in supplementary medical insurance paid 6228 yuan)
In Chongqing:
For example, Li San: a full-time worker (who has participated in supplementary medical insurance), aged 53, was hospitalized in the former Neijiang Railway Hospital, with medical expenses of 1, 680 yuan. The threshold hospitalization fee is 5.6 (the threshold of 640 US dollars stipulated by the local government), and the expenses for using one's own medicines, diagnosis and treatment items 1 10 yuan, and the expenses for Class B medicines and diagnosis and treatment items are paid according to 420 yuan.
Medical expenses that meet the requirements of basic medical insurance:
1680-110-420× 20% =1486 yuan
1, basic medical insurance reimbursement:
(1486-560) × 75% = 694.50 yuan.
2. Supplementary medical insurance reimbursement: (1) The threshold fee is divided into two parts: BR/& gt；; (1) reimbursement threshold: 560× 30% = 168 yuan.
Above and below the top line reimbursement:
(1486-560-694.50) × 70% =162.50 yuan.
3 basic+supplementary total reimbursement:1680-694.50-330.05 = 655.45
694.5 330.05 = 1024.55
Personal out-of-pocket part:
/& gt； (Not in conformity with relevant policies, specific provisions of regional master planning and coordination)?
3, what is the basic medical insurance reimbursement regulations?
1, general principle: self-retention, class B drugs and items exceeding the project cost by 20%, etc., basic medical insurance expenses are reimbursed, and supplementary medical insurance is not reimbursed.
2 basic medical insurance Qifubiaozhun (expenses exceed this standard before reimbursement) is as follows:
(1) Qifubiaozhun for each transmission: Level-I hospitals are 400 yuan and 650 yuan, and Level-III hospitals are 970 yuan. Polls show that when there are more than two times (including two times) in a natural year, the minimum threshold for staying in a second-class, second-class and third-class hospital is gradually lowered according to 80 yuan. Fees below the minimum amount should be paid through personal account or cash.
(2) Tertiary hospitals and medical institutions: 900 yuan and 700 yuan, secondary hospitals and medical institutions, and other medical institutions 500. Natural hospitalization for many times within one year, according to the above standards to 200 yuan. Minimum threshold fee 300 yuan; Third-level hospital, second-level hospital 200 yuan; Other medical institutions 100.
According to the above standards, the threshold fee for retirees has been reduced by $200, but it is not lower than the minimum threshold fee.
(3): The first-class hospital is located in 400 yuan, the second-class hospital in 640 yuan and the third-class hospital in 880 yuan.
I have been hospitalized in Chongqing Railway Hospital for one year, and the minimum threshold has been continuously reduced by 1 percentage point on the basis of the above standards.
3, the basic medical insurance fund cap line (the highest amount of reimbursement and outpatient expenses for specific diseases within one year):
(1) In Sichuan, the current standard is 35,000 yuan/year.
(2) The current standard in Guizhou is 39,000 yuan/year.
(3) The current standard in Chongqing is 32,000 yuan/year.
What is the standard of hospitalization medical expenses?
1, basic medical insurance reimbursement:
Only the expenses of the deductible line can be reimbursed, and the part above the capping line is paid by the fund. BR/>； (1) Sichuan:
Reimbursement amount = (total cost-threshold fee-self-funded part-Class B drugs, and pay 20% of part of the cost of this project) (75%+age × 0.2%).
(2) In Guizhou: Above.
The part of the threshold fee of 5000 yuan (including 5000 yuan, the same below), the personal burden of 20%; 5000- 10000 yuan, personal burden15%; To 15000 yuan, 10000 yuan, 10% personal burden; 15000 to the capping line, 5% shall be borne by the individual, and the rest shall be paid by the overall fund.
(3) Chongqing unit:
Medical expenses include $5,000. For service personnel with a cost of $5,000, 70% of the threshold fee will be paid for those under 45 years old and over 45 years old (75% for employees, including 45 years old) and 85% for retirees; Pay for rest.
(including 10000 yuan), medical expenses below 5,000 yuan 10000 yuan, employees' wages are reduced by 75% to below 45 years old, employees on the job pay 80%, and those over 45 years old (45 years old) pay 90% for retirement; Pay the rest
For medical expenses with the maximum amount of 1 10,000 yuan or more, if the employee is over 45 years old but under 45 years old, 80% will be paid by the employee (45 years old), 85% by the retiree and the rest.
Payment amount of the overall fund = (total hospitalization expenses-Qifubiaozhun-self-funded Class B drugs and medical treatment project expenses that pay part of the expenses × 20% )× corresponding proportional coefficient.
2. Supplementary medical insurance reimbursement:/> (1) threshold fee for overall planning of basic medical insurance fund
The "threshold fee" of the former railway hospital: 60% of the 30% registered employees who enjoy subsidies are retirees.
(2) If the expenses exceed the deductible line of basic medical insurance, the fund will pay the following parts: the fund balance, 70% of registered employees who supplement insurance benefits, and 90% of retirees.
(3) Upper limit co-ordination fund: supplementary insurance benefits, 90% registered employees and retirees.
(4) Top line of supplementary medical insurance fund (maximum annual reimbursement amount): within a natural year, supplementary insurance can be reimbursed 6,543,800 yuan+0.5 million yuan. BR/>；
New reimbursement scope of rural medical insurance
Chengdu High-tech Zone, reimbursement scope
The designated medical institutions for farmers' social insurance in High-tech Zone (see Annex II) shall reimburse the medical expenses, diagnosis and treatment items and medical service prices using Chengdu drugs and new rural insurance subsidy funds within the scope of the list of basic medical insurance drugs in Sichuan Province.
Farmers' medical expenses such as work-related injuries and disabilities are solved by employers. Does it belong to the reimbursement scope of the new rural medical insurance fund?
2. Reimbursement standard
(1) outpatient medical expenses
If the outpatient treatment cost of the local street community health service center (station) exceeds 10 yuan, the fixed subsidy per person per year will be 10 yuan; Not more than 654.38 million yuan, according to the actual amount of subsidies.
(2) Hospitalization expenses
In district hospitals, 45% of the community health service institutions paid 100 yuan for medical treatment, while 35% paid 300 yuan for medical treatment in the designated social security second-class hospitals in the district, and the district community health service institutions issued hospitalization referral certificates; The hospitalization in the Third Hospital of the social security payment point in this district is 7 million US dollars, and the referral certificate with the community health service institutions in this district is 25% repeated reimbursement.
Farmers in different places (outside Chengdu) social insurance designated medical institutions for hospitalization expenses reimbursement of 25%, the rest of the expenses reimbursement, except at their own expense.
Individuals are hospitalized many times throughout the year, and medical expenses are settled at different levels. The annual personal reimbursement amount shall not exceed 12000 yuan.