Participating residents in different categories of designated medical institutions hospitalized in accordance with the provisions of the medical expenses incurred in the starting standard above the maximum payment limit, in accordance with the following proportion:
A class of designated medical institutions (including community health service institutions), the integrated fund to pay 60%, the individual to bear 40%;
Two categories of designated medical institutions, the integrated fund to pay 55%, the individual to bear 45%;
Three categories of designated medical institutions, the integrated fund to pay 50%, the individual to bear 50%;
Three types of designated medical institutions, the integrated fund to pay
The second type of designated medical institutions, the coordinated fund pays 55%, and the individual bears 45%;
The third type of designated medical institutions, the coordinated fund pays 50%, and the individual bears 50%;
The insurance year of the residents' medical insurance is calculated on the basis of the natural year, and the maximum payment limit of the coordinated fund is 25,000 yuan (including the costs of inpatient and outpatient prescribed medical types) in one natural year.
Expanded Information
What is within the reimbursement catalog of the medical insurance can be reimbursed by the medical insurance, and what is not within the scope of reimbursement by the medical insurance is not reimbursed.
ICU can be reimbursed for cardiac monitoring fees, ventilator fees, injection fees, diagnostic fees and other items in the medical insurance reimbursement catalog. If you use imported drugs that are not in the Medicare reimbursement catalog, you will not be reimbursed. The local social security bureau will determine the catalog of the medical insurance.
Taking Zhengzhou as an example, according to Article 23 of Zhengzhou Urban Residents' Basic Medical Insurance Measures (for Trial Implementation), newly insured residents who have paid their basic medical insurance premiums in full and on time are entitled to a waiting period of three months for inpatient medical insurance treatment and outpatient treatment of specified diseases, which is counted from the first month of the effective date of the basic medical insurance. Medical expenses incurred during the waiting period shall be borne by the individual and shall not be paid by the integrated fund.
Article 34 stipulates that the list of medicines, the list of diagnostic and therapeutic items, the scope of medical service facilities and the payment standards for the residents' medical insurance shall be formulated separately by the Municipal Labor and Social Security Department. Medical expenses exceeding the scope of the catalog shall not be paid by the integrated fund.
Article 35 stipulates that the portion of hospitalization medical expenses incurred by insured residents at designated medical institutions shall be paid by individuals in cash or in their individual accounts, while the portion to be paid by the integrated fund shall be recorded by the designated medical institutions.
Baidu Encyclopedia - Measures for Basic Medical Insurance for Urban Residents in Zhengzhou City (for Trial Implementation)