Total outpatient visits per month 15 or more; General outpatient visits have accumulated more than 30 times for 3 consecutive months; The monthly medical expenses of general outpatient service accumulated more than 6000 yuan; In the same medical insurance year, the total medical expenses of general outpatient clinics exceeded 20,000 yuan; When the personal account is used up and enters the "self-funded period", it is necessary to use the basic medical pooling fund and the local supplementary medical insurance fund; There is a report in violation of the provisions of the Measures.

Scope of use of medical insurance card

First, outpatient and emergency expenses.

1. The medical expenses above 1800 yuan can only be reimbursed after the on-the-job employees see a doctor in the emergency department of the hospital, and the reimbursement rate is 50%.

2. Retirees under the age of 70,1.Expenses above 300 yuan can be reimbursed, and the reimbursement rate is 70%.

3. Retirees over 70 years old,1.Expenses above 300 yuan can be reimbursed by 80%.

Second, the hospitalization expenses.

The maximum annual payment limit (hospitalization expenses) of the basic medical insurance pooling fund is currently 70,000 yuan.

1, the standard of hospitalization reimbursement is related to the level of the hospital where the insured person is located. If you live in a tertiary hospital, the employee pays 15%, which is 85% of the reimbursement, from the minimum threshold to 30,000 yuan.

2, 30,000 yuan to 40,000 yuan, the employee's individual contribution 10%, 90% reimbursement;

3, more than 40000 yuan to the maximum payment limit, 95% can be reimbursed, employees only need to pay 5%.

4. The individual contribution ratio of retirees is 60% of the on-the-job (i.e. the above) employees, but all below the threshold is paid by individuals.