The urban residents medical insurance does not include large supplemental medical insurance, whether you can participate in depends on whether the local supplemental medical insurance.
The difference between urban residents' medical insurance and large supplementary medical insurance:
I. Urban residents' medical insurance reimbursement scope
(A) Diagnostic and therapeutic equipment and medical materials
1, the application of x-ray computed tomography (ct), stereotactic radiography (γ -knife, χ-knife), cardiac and angiography x-ray machine (including digital subtraction equipment), nuclear magnetic **** vibration imaging device (mei), single-photon emission computerized scanning device (spect), color Doppler, medical linear gas pedal and other large-scale medical equipment for the examination, treatment projects;
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2, extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy
3, pacemakers, artificial joints, artificial crystals, vascular scaffolds in vivo replacement of artificial organs, in vivo placement of materials
4, the provincial pricing department can be charged separately for disposable medical materials.
(B) treatment project category
1, hemodialysis, peritoneal dialysis
2, kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation
3, cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects.
(3) Examination and treatment items of medical instruments and equipment and medical materials with a single cost of more than 400 yuan.
Two, large supplementary medical insurance compensation
Participants in the large medical insurance payment after entering the hospitalization, outpatient emergency rescue and in outpatient treatment of serious diseases, chronic diseases in line with the provisions of the basic medical insurance medical costs, by the large medical insurance fund and the participant in proportion to the proportion of segmented cumulative, **** the same burden. Specific standards are as follows:
(a) for the portion of more than 45,000 yuan to 100,000 yuan (including 100,000 yuan), the large medical insurance fund pays 94%, and the insured person pays 6% out of pocket; for the portion of more than 100,000 yuan to 200,000 yuan (including 200,000 yuan), the large medical insurance fund pays 96%, and the insured person pays 4% out of pocket; for the portion of more than 200,000 yuan, the large medical insurance fund pays 98%, and the insured person pays 2% out of pocket. The insured person pays 2% out-of-pocket.
(2) The medical expenses of the insured persons for the use of the diagnostic and treatment items which are partly paid by the Basic Medical Insurance Coordination Fund and the Class B medicines in the Basic Medical Insurance Drug List shall be paid by the individuals 10% in advance, and for the medical expenses for the use of blood which are approved, the individuals shall pay 30% of the medical expenses in advance, and the balance of the expenses shall be borne by the large-scale medical insurance fund and the insured persons according to the regulations and in proportion to the proportion of the medical expenses.
(3) the use of basic medical insurance participants in line with the provisions of the replacement of artificial organs in the body, the body of the material, of which is domestic, by the individual to pay 35%%, the large medical insurance to pay 65%; belonging to the imported, by the individual to pay 50%%, the large medical insurance to pay 50%.
The maximum amount of medical expenses paid by the large medical insurance is 300,000 yuan for each insured person in one insurance year.
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