1. General medical insurance premium refers to the necessary and reasonable medical expenses paid by individuals due to accidents or diseases after the waiting period, including hospitalization expenses, special outpatient medical expenses, outpatient surgery expenses and outpatient emergency medical expenses for 30 days before and after hospitalization. After deducting the deductible100,000, it will be reimbursed according to the proportion of 100%, and a total of 3 million will be paid every year.
2. The medical insurance fund for serious and serious diseases, 100 kinds of serious and serious diseases, including hospitalization expenses, special outpatient medical expenses, outpatient surgery medical expenses and outpatient emergency medical expenses for 30 days before and after hospitalization, shall be paid to the insurance fund according to the compensation ratio of 100%, with a cumulative annual payment of 6 million yuan.
3. The proton heavy ion medical insurance for malignant tumor is paid according to the proportion of the insured amount 100%, with an annual cumulative payment of 6 million yuan, and the bed fee limit is 1500 yuan/day.
4. For the drugs specially used for malignant tumors outside the hospital and those that meet the scope agreed in the contract, the insurance premium shall be paid according to the compensation ratio of 100%, with a cumulative annual payment of 6 million yuan.
5. The insurance premium of special equipment and consumables for malignant tumor is applicable to the expenses of female insured for treating severe breast cancer and breast prosthesis reconstruction for the first time. According to the ratio of 100%, the annual cumulative payment limit is 1 10,000.
6. The medical insurance premium for specific drugs for minor and rare diseases, which is practical and reasonable, is necessary for treatment, and meets the specific drug expenses, shall be paid at the rate of 100%, with the annual cumulative payment limit of 1 10,000.
7. The expenses for minors' specific equipment and consumables, medical insurance and insulin pump equipment for the treatment of type I diabetes are paid at the rate of 1 0,000%, and the annual cumulative payment limit is 1 10,000 yuan.
Abstract: exemption clause:
1. If the individual payment is within the deductible stipulated in the policy, the claim will not be settled; Insurance for social security but not medical insurance for social security, according to the proportion of compensation agreed in the policy;
2. Before the first insurance or re-insurance within the specified time limit after the last policy expires, no claims will be made for past diseases or congenital diseases;
3. If the examination results are abnormal before insurance or during the waiting period, the doctor suggests further review, and the disease diagnosed after the waiting period will not be settled;
4. Non-second-level or above public hospitals seek medical treatment and have no claims; Special wards, foreign guests' wards or other high-end wards that do not belong to the basic medical insurance will not be settled (except special medical care);
5. Medical insurance payment, public expense reimbursement and third-party reimbursement will not be settled; Non-disease treatment is not settled.