First, the medical insurance for urban workers and their treatment.

1. The basic medical insurance for employees is a basic medical insurance system aimed at all employers and employees in cities and towns, including employees and retirees of state organs, enterprises and institutions, and gradually extended to flexible employees, with the principle of compulsory participation.

2. Basic medical insurance standard for employees: According to the current national regulations, the payment scope of basic medical insurance for employees is divided into pooling funds and individual accounts, which are accounted for separately and shall not occupy each other. Personal account is used for payment door.

Outpatient and hospitalization expenses and expenses for purchasing medicines at designated pharmacies. Personal accounts are for personal use and can be carried forward and inherited. The overall fund is used to pay for hospitalization and some outpatient serious illness expenses, with Qifubiaozhun.

Specific standards and limits are determined by the overall planning area according to the principle of balance of payments. Medical expenses below Qifubiaozhun shall be paid by personal account or borne by individuals; Above qifubiaozhun, at most

Medical expenses below the high payment limit are mainly paid from the overall fund.

Two, medical insurance for urban residents and their treatment.

1, the basic medical insurance system for urban residents is a basic medical insurance system for urban non-employed residents, which focuses on serious illness as a whole. Primary and secondary school students (including students from vocational high schools, technical secondary schools and technical schools), children and other non-employed urban residents who are not covered by the basic medical insurance system for urban workers may voluntarily participate in the basic medical insurance for urban residents.

2. Standards for financing and treatment of basic medical insurance for urban residents: The financing of basic medical insurance for urban residents adopts a combination of individual contributions and government subsidies. The individual's contribution level is based on the local economic development level and adulthood.

The basic medical consumption needs of adults, minors and other different groups of people, and consider the affordability of local residents' families and finances, and appropriately determine the financing level. People who enjoy the minimum living security, disabled people who lose their ability to work, and people with low incomes.

The government will subsidize the individual contributions required by the elderly and minors over 60.

Three, the new rural cooperative medical system participants

1. Compared with the traditional rural cooperative medical system before the reform, the new rural cooperative medical system is an economic system of mutual medical assistance for farmers, which is organized, guided and supported by the government, and farmers voluntarily participate, and individuals, collectives and governments raise funds in various ways.

2. The treatment standard of the new rural cooperative medical system is to mainly subsidize the large medical expenses or hospitalization expenses of the participating farmers.

3. Rural residents who are willing to abide by the relevant rules and regulations of the new rural cooperative medical system and pay the participation fee in full and on time may voluntarily participate in the new rural cooperative medical system on a household basis.

(1) Rural residents within their respective administrative areas;

(two) rural residents who go out to work, do business or go to school for more than half a year may voluntarily choose to participate or not;

(three) rural primary and secondary school students should participate in the new rural cooperative medical system with their parents in the domicile. Migrant farmers and their families, rural students studying in cities can voluntarily choose to participate in the new rural cooperative medical system or the basic medical insurance for urban workers and urban residents, but they may not participate or enjoy treatment repeatedly;

(four) who participated in the medical insurance for urban workers, the basic medical insurance for urban residents or the new rural cooperative medical system in other areas, shall not participate in the new rural cooperative medical system.

According to the provincial and municipal documents, the reimbursement scope of the new rural cooperative medical fund is as follows:

(a) beyond the "new rural cooperative medical care in Sichuan Province (Revised Edition)" and the national list of essential drugs.

(two) not included in the "basic diagnosis and treatment project of new rural cooperative medical system in Sichuan Province (Trial)" costs.

(three) the cost of family planning operation and the cost of pregnancy in violation of the family planning policy. Medical expenses such as infertility and sexual dysfunction treatment.

(four) medical expenses borne by the third party or other responsible parties due to medical accidents or disputes, and the expenses that should be borne by the medical party. (5) Injuries caused by alcoholism, drug abuse, suicide, self-mutilation, fighting, self-injury by motor vehicles (including battery cars and power-assisted motorcycles), illegal crimes, and medical expenses incurred during detention, arrest and imprisonment.

(6) Non-medical expenses: such as insurance premium, escort fee, escort utility fee, escort bed chair fee, air conditioning fee, home visit fee, transportation fee, first aid fee, birth certificate fee, nutrition fee and other miscellaneous fees.

(7) Non-basic medical expenses: all kinds of non-therapeutic beauty, plastic surgery, hair dyeing, radical cure of body odor, installation of artificial limbs, dentures, artificial eyes, wigs, optometrists, hearing AIDS, walkers, crutches, wheelchairs, etc. ; All kinds of weight loss,

All expenses for fattening and higher projects; Expenses for various self-use health care, physical therapy, magnetic therapy, massage, examination and treatment equipment; All kinds of medical consultation and medical appraisal fees. Apart from polio, congenital cleft lip and palate,

Congenital dislocation of hip joint, defects other than congenital heart disease, and expenses incurred by unapproved orthopedics and orthodontics.

(8) Disposable daily consumables used by patients: such as urinals, pots, buckets, disposable bedpans, urine pads, diapers, toilet paper, disposable shoe covers, cleaning bags, etc.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.